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Posted 10/29/2013 11:26 AM (GMT 0)
Hereabouts, BCBS is known for crazy price hikes. My employer has always offered BCBS as a somewhat expensive option, which I chose, but this year we dumped them because the rates were going to go through the roof.

We have other options now, and I wasn't too happy with the change, but after checking out a new PPO option, I'm pretty happy. Coverage is the same (if not better, especially for women), doctors are the same, and the deductible is reasonable ($500) as are copays. Amazingly, my portion of the premium will be something like 90% lower than with BCBS. I'm still wrapping my head around that one.

I am technically a public employee, so some of these decisions were also informed by new state regulations that cap employer contributions. And that had everything to due with legislative antipathy toward public employees.

 

Posted 10/29/2013 1:26 PM (GMT 0)
Obamacare = no lifetime maximums.

I can imagine that helps a lot of us. Multiple colonoscopies, years of Remicade, etc. and then possibly surgery could easily cost more than $1 million or whatever the lifetime maximums used to be.

Anyone on this board finally able to get individual insurance because of the no exclusion for pre-existing conditions clause?

I'm willing to bet that a lot of folks are going to get premium refunds at the end of the year because the insurance companies didn't meet the 80% threshold. They insurance cos. are taking advantage of the frenzy around Obamacare-raising prices and profiting on a 12 month float on millions (billions?) of dollars.
Posted 10/29/2013 1:41 PM (GMT 0)
All I know absolutely for sure is what is happening to me. Anthem never dumped me because of my UC, even though they charged me higher rates due to my UC but, as it turns out, these higher rates are actually cheaper than my listed Obamacare rates. Even though my policy was expensive (again, cheaper than Obamacare) my insurance was great and comprehensive. It was not crappy insurance. It was a PPO and I could go to any doctor I wanted, any facility I wanted, and nobody ever told me something was not covered, such as expensive prescriptions or that I had to try a cheaper med first. The best Obamacare policies available to me are HMO's, which is a lot crappier insurance than I currently have and I would have to change almost every doctor I currently have. Currently if my doctor wants to prescribe Uceris or biologics my insurance will cover it but the HMO will be saying, "Hey, wait a minute, you have to try this other first."

Obamacare is actually called the "Affordable Care Act" (for short) but what good is it if it is actually not affordable now, but will supposedly be affordable years down the road when everything starts running more smoothly? Yeah, right. I've go some oceanfront property for sale in Iowa if anyone is interested. When has any government program become cheaper down the road? A lot of people are only addressing the premium angle because that is what the administration is harping on, being able to get "affordable" health insurance coverage (especially with the subsidies available), but, oh, by the way, if you use your insurance a lot your affordable family coverage is going to cost you over $12,700 per year with no subsidies available for that, but, hey, you can get preventative medicine for free."

I'm not an anti Obama right wing nut or listen to the garbage they spew. I'm just a ordinary moderate US citizen who is getting screwed because of these changes and I should have been one of the ones where Obamacare helped. I'm not saying that everyone is going to be a loser but I sure am and from what I have seen there are going to be way more losers than winners when you factor in the out of pocket expenses which will take many by complete surprise after the fact. It's hard to justify that Obamacare's policies are more comprehensive when you're shelling out over twelve grand in possible provider and prescription costs every year. Most families cannot afford that, even if they pay little for the actual premiums themselves. I've never personally known anyone who hit their lifetime insurance limit maximums except for the occasional horror story in the news and what difference does it really make if you can now obtain health insurance when you couldn't before if you still get stuck with $12,700 in out of pocket costs plus the cost of your premiums? That sounds to me like a shell game from what is happening before Obamacare where people won't be able to pay their medical bills and will have to file bankruptcy under either system. Most of the real winners are going to be those that have the peace of mind in knowing that they now have affordable premiums but don't wind up using their insurance much.
Posted 10/29/2013 1:54 PM (GMT 0)

kiptyn said...
Obamacare = no lifetime maximums.

I can imagine that helps a lot of us. Multiple colonoscopies, years of Remicade, etc. and then possibly surgery could easily cost more than $1 million or whatever the lifetime maximums used to be.

Anyone on this board finally able to get individual insurance because of the no exclusion for pre-existing conditions clause?

I've always had no-life-time maximums and no pre-existing conditions because I live in NY but these clauses do cost the industry money and that is one of the reasons our premiums were always higher than the National averages. But I was always thankful that these were the part our health care regulations in NY. I am well over a million dollars in claims in my 8 years of UC, I've had (2) $250,000 hospital stays for over 20 days each time, plus all my doctors visits and biologicals.

I've been offered good jobs out of state but could never take them due to my health issues and not being able to risk not being covered for health insurance; thanks to Obamacare I can take a job anywhere in the Country or even start my own business in a different state.

Because NY State had these policies in place prior to Obamacare we are expecting to see premium pricing to come down for many insurance policies (but not all).

kiptyn said...

I'm willing to bet that a lot of folks are going to get premium refunds at the end of the year because the insurance companies didn't meet the 80% threshold. They insurance cos. are taking advantage of the frenzy around Obamacare-raising prices and profiting on a 12 month float on millions (billions?) of dollars.

That is a good point and we may see this happen but if they don't sign up enough people for insurance then I doubt this will happen. They need to sign up younger healthier Americans to keep the costs down for the first year, if not, then the insurance companies may not be at that 80% number.

This is a long-term program and we need to have patience; it will take years for the program to take effect and stabilize the health insurance industry. Long-term this will be a good program for almost everyone but it will take time. I predict as time goes on that premiums will go down for almost everyone from the upcoming year's premiums. I really don't think we can judge ObamaCare by the upcoming first year, it is too big a change with too many moving parts to know exactly how things will be but there are a lot of great new features to our Health Insurance/Medical Industry that will positively affect everyone.

Sure some people will pay more for insurance but they will be getting much better coverage and benefits; $100-$150 a month health insurance doesn't cover anything and will probably still bankrupt you if you had a major medical issue. Health Care is expensive in the US, insurance premiums must reflect that, otherwise insurance doesn't work.
Posted 10/29/2013 2:12 PM (GMT 0)
ks1905 - exactly! Thanks for posting such a calm and forward looking viewpoint. Change is hard.
Posted 10/29/2013 2:47 PM (GMT 0)

garylouisville said...

Obamacare is actually called the "Affordable Care Act" (for short) but what good is it if it is actually not affordable now, but will supposedly be affordable years down the road when everything starts running more smoothly? Yeah, right. I've go some oceanfront property for sale in Iowa if anyone is interested. When has any government program become cheaper down the road? A lot of people are only addressing the premium angle because that is what the administration is harping on, being able to get "affordable" health insurance coverage (especially with the subsidies available), but, oh, by the way, if you use your insurance a lot your affordable family coverage is going to cost you over $12,700 per year with no subsidies available for that, but, hey, you can get preventative medicine for free."

We have all ready had all the policies in place in NY for years which raised our premiums, now that there are more people participating in health care in NY and efficiencies are coming into effect we expect premiums go down on many policies. I just checked the NY State Website and you can get a Silver Plan for $9 a day ($270 a month) for an individual (I'd have to give them all my info for a family plan which I didn't want to bother doing) before any subsides, which I personally think is affordable when many people pay a few dollars a day for Coffee, lotto tickets and cable TV.... It's all about priorities. It's about $13 a day for a Gold Plan and $15 a day for Platinum.

If you live in Kentucky (I'm guessing) your Governor has been all over the news saying how bad Kentucky's health insurance system was over the years with many uninsured or underinsured citizens and the ACA gives it a chance to fix many of the problems that it had. Maybe you had great insurance but many of the people in Kentucky did not.

By the way I will be way over a Million dollars in lifetime claims from 2 long-term hospitals stays, Remicade, doctors visits, and my 3-step J-pouch.
Posted 10/29/2013 10:12 PM (GMT 0)

gary said...
"anti Obama right wing nut or listen to the garbage they spew.

So anyone who disagrees is a garbage spewing nut? That's a pretty big brush you're using.


In my case my monthly payment went up about 15 pc YOY and brand name medicine went from 70-100$ and GI visits about the same increase, FWIW.
Posted 10/29/2013 10:27 PM (GMT 0)
KS: I do live in Kentucky. The state exchange policies available to my family of five are all between $10,000 - $20,000 per year in just premiums alone, which is one hell of a lot of dough. That doesn't count the family out of pocket expenses of $12,700 per year, which makes a grand total of $22,700 - $32,700 in annual medical expenses. Where does "affordable" come in to play?

            In addition to that the Obamcare policies are actually crapola compared to the plan I have now, PPO vs HMO where I would have to change almost all of my doctors and have a miniscule network and it also doesn't account for the fact that I lose the tax deduction status of my HSA account because the state exchanges do not carry policies that qualify for HSA status. All of the examples you give are exactly what I am talking about. The pro-Obamcare people only talk about the cost of the premiums and subsidies and conveniently forget to mention that any "family" of two or more could be facing out of pocket expenses of $12,700 per year which is not affordable for many, even if subsidies make their premiums close to zero. The out of pocket expenses are not subsidized. I'm not here to attack Obamacare but the fact is most people can't afford these out of pocket family expenses even if their premiums are free. I don't think it even really matters what state you are in because these outrageous out of pocket expenses are going to apply to every state if you get the lower cost plans. If you get the higher cost plans to cut down on the out of pocket expenses then of course you will be paying much more for the premiums.

        The insurance will be a godsend for those people who will have more affordable premiums and those with pre-existing conditions - as long as they don't use the insurance much. That's the caveat. Once they get those bills in the mail totaling $12,700 for family copays and out of pocket expenses and for those expensive meds they will also wonder what happened to the "affordable" in the Affordable Care Act. Are you saying that I should be happy to pay over $30,000 per year in total healthcare and premium costs, just so the rest of Kentuckians can get better healthcare? I'm one of the ones (with pre-existing conditions) that Obamacare was supposed to help. I'm not saying that everyone is going to get screwed but you have to account for the out of pocket expenses in these plans when figuring out what the plan is actually going to cost you and for just about all "families" these backdoor out of pocket expenses are going to send them to the very same bankruptcy that they are eligible for now under the current system.

Posted 10/29/2013 11:36 PM (GMT 0)

garylouisville said...
KS: I do live in Kentucky. The state exchange policies available to my family of five are all between $10,000 - $20,000 per year in just premiums alone, which is one hell of a lot of dough. That doesn't count the family out of pocket expenses of $12,700 per year, which makes a grand total of $22,700 - $32,700 in annual medical expenses. Where does "affordable" come in to play?

Who said you had to buy an exchange plan? I won't be buying an exchange plan because I like my current insurance and I won't qualify for any subsides. I figure that many of the people who are buying the exchange plans are people who qualify for subsides.

Family of 5 at your max of $33,000 for 12 months is $550 per person per month. That is $18 a day per person which isn't cheap (on the low end of your number you are looking at $13 a day per person or $383 per month) but I don't think it's unreasonable; maybe you can find something for less money on the private markets.

You mention affordability; Both health care and children are very expensive, especially 3 children who need health care but not having health insurance and needing major medical care for a child or yourself could bankrupt you without the proper coverage.
Posted 10/30/2013 12:03 AM (GMT 0)
Here is some of what is going on Aetna CEO.

Also watch the video. Extra taxes,extra mandates and extra whatever.

OM

http://www.cnbc.com/id/101153188

Posted 10/30/2013 12:31 AM (GMT 0)
I can stay on my current "grandfathered" plan until June 30th, after which I'm sure I will be one of those getting a cancellation letter. I have a health insurance agent who has been looking into my options but so far all he talks about is the state exchange. I'm guessing that means the plans outside of the exchange are even worse. I guess part of my point is that I cannot afford $25,000 - $35,000 per year as it would bankrupt me so I seem to have a choice of going bankrupt from those costs or just not having health insurance at all and going bankrupt from that if something really bad happens. That's what Obamacare was supposed to fix. Right now, if nothing bad were to happen to any of us, it would be cheaper for me to pay for meds and doctors directly with no insurance than to have high family health insurance premiums plus having to pay and additional $12,700 on top of that. Before Obamacare I was just barely handling it. Now I am considering the reality that if I had no insurance I would be far better off, probably saving a good $10,000 per year, if not more, as long as there was no catastrophic event. I am actually better off than a lot of families and another point I was making is that families with far less income than I have, even if their policies were very well subsidized, they would not be able to afford $12,700 in yearly out of pocket expenses for a family of as little of 2 or more. Most families that would get subsidies could not afford that much in family out of pocket expenses.
Posted 10/30/2013 2:19 AM (GMT 0)
"KS: I do live in Kentucky. The state exchange policies available to my family of five are all between $10,000 - $20,000 per year in just premiums alone, which is one hell of a lot of dough. That doesn't count the family out of pocket expenses of $12,700 per year, which makes a grand total of $22,700 - $32,700 in annual medical expenses. Where does "affordable" come in to play?"

I can't log into the KT site. Can you do a screen shot? Seems unbelievable.

Move to AZ. I can buy a totally unsubsidized platinum plan for $5942 in premiums and a out of pocket of $1250. I am 54 and in the high dollar bracket. I don't go to the doctor much and use only a single generic med but that would be a Godsend to somebody serious ill with UC. The year I was diagnosed I spent $12,000 including premium,coinsurance and copays. Could have been worse. Worse case $7200 sounds great to me.

By the way evil Obamacare created generic biologicals. Those drugs cost $5000 a month today. Most policies require at 45% copay until you hit deductible.
Posted 10/30/2013 2:43 AM (GMT 0)
AZ: Are you talking about a single policy for just you? If so, the difference is I am a family of five. Multiply all of your figures by a factor of five and you are approximately at the costs I described. Actually, my costs might be lower than Arizona. Just for the sake of argument, go on your exchange (don't know if Arizona has it's own or not) and put in a hypothetical family of five and see what happens. My wife and I are both in our 50's, nonsmokers, and have three dependent children. We would get a subsidy of approximately $3700 per year for a much worse HMO policy but my out of pocket family costs zoom from 6 grand to the $12,700. With UC you have to figure maxing out on your out of pocket. You would be in for a very rude awakening if you didn't and had a bad year. It's hard enough to raise a family without having to spend over 20 g's on just healthcare alone. I do all right financially but really can't afford to spend that much on healthcare alone. Something has to give somewhere.
Posted 10/30/2013 4:31 PM (GMT 0)
AZYooper - I hope you have been watching CNN today as they have proved my point.
Posted 10/30/2013 4:52 PM (GMT 0)
Mike,
No they didn't and you made a unsupported claim not a point.
Posted 10/30/2013 5:26 PM (GMT 0)
Gary,

There are big problems with the information on most of the insurance company sites regarding silver plans. If you are eligible for subsidy of the premium amount you might also be eligible for cost share reduction. This only applies to silver plans and reduces your out of pocket so they become gold or platinum plans.

The $12,700 you keep quoting is the maximum amount allowed for a policy to be sold on the exchange not a minimum. Policies are available with much lower out of pockets. That is just the maximum allowed for people older than age 30. The platinum plans are $2500-3000 on the exchange here for a family and $1250-1500 for an individual. Gold plans are also much lower. If you have a expensive chronic condition the platinum plans are definitely worth it. The plan I quoted before would have a $1500 deductible, $2500 out of pocket for a family. I can't tell you what an exact family premium is but an estimate with no subsidy is $826.

I currently have a fairly good plan grandfathered since 2010 which will still be offered. It is listed as a $6500 out of pocket in network($13,000 out) BUT it has no drug maximum. If I was on Remicade my actually out of pocket would be 20% of the cost of remicade plus all my drug copays plus $6500. Also out of network and in network deductible are not added to together. To compare to the exchange plans I really have a worse case of unlimited out of pocket. This is a good plan and it is grandfathered even if you bought it after 2010.
Posted 10/30/2013 6:54 PM (GMT 0)
AZ: I am currently on an Anthem PPO "grandfathered" plan until the policy runs out on June 30th. I've never had any problems with coverage, ever. I'm not 100% sure what "grandfathered" means. I have been assuming it meant that, even though my policy details do not comply with the new Obamacare mandates (even so, the policy is still much better than my state's least expensive HMO plan) that the policy would go on as is until June 30th and I have gotten a letter from Anthem basically stating that. Does "grandfathered" mean that I could still continue on with a renewal after June 30th, or will I get a cancellation notice at that time because it would no longer comply with the new Obamacare guidelines at renewal time? My insurance agent seemed to think the policy would probably be able to be renewed and still grandfathered but he expected Anthem to raise the rates so high that it would probably not be an affordable option to renew, forcing me down the Obamacare road come July 1st. If that is what is going to happen it may be better for me to go down the Obamacare road starting January 1st. Otherwise I will never meet my deductible under my current policy by June 30th and then I will have to start all over from square one again and not be able to meet my deductible the second half of the year either. Right now it looks like all of my options suck unless grandfathered means I can stay with my current insurance even at renewal time July 1st and they do not raise my rates up substanially.
Posted 10/30/2013 7:40 PM (GMT 0)
Grandfathered refers to individual plans you were on before March 23, 2010. They escape almost all the regulation changes. Don't have to cover maternity, children to 26, free prevention etc. I have a BCBS AZ PPO and it covered a lot of it anyway. I got a letter from them last month telling me I have a grandfathered plan under the ACA.

The big issue in the news now is that most people with individual coverage don't have a grandfathered plan. Most of them bought after that date. A minority had insurance companies that changed the plan and voided the grandfathered status.

Another issue is defining what the "essential benefits" are was left up to the states. The ACA only has an outline and the states are left to define it in state regulations. Some states voided policies intentionally or not.

I can't tell you I am 100% sure but if you don't get a notice for January 1, 2014 I think you are not going to have your plan canceled. Pretty sure the law requires 90 days notice of that also.

Cost share reduction is based on percentage of poverty level. A family of 5 would get at least some cost share reduction at $67,000 income.

http://www.healthpocket.com/individual-health-insurance/cost-sharing-reduction-silver-plan

I can't get a HMO(none available here) but from what I can tell in Tucson they are much less expensive and the same doctors and hospitals are in both the HMOs and PPOs for the same company. Don't understand that at all but if I could get a HMO I would be looking into it. They run nearly $150 a month cheaper for me and have the same out of pocket and drug list. $350 unsubsidized for a platinum plan. But Arizona is the second cheapest state and Tucson the cheapest city in the state for healthcare.

I might pay my premium in January (it is 3 months at a time) if the information on the law doesn't improve. The issue that isn't being reported is that the insurance companies are all behind. Haven't finalized PPOs, drug lists etc.
Posted 10/30/2013 8:05 PM (GMT 0)
My policy will not be cancelled January 1st. I did get a letter already stating that my policy is grandfathered and will continue until June 30th but my question is, am I going to get a cancellation letter several months from now saying my insurance will end June 30th because it cannot be grandfathered when it is renewal time? Or does grandfathered mean I can keep on renewing it year after year, forever?
Posted 10/30/2013 8:50 PM (GMT 0)
AZYooper - Obviously you didn't watch it then, because my point was proven. Done discussing this with a closed-minded person.
Posted 10/30/2013 9:06 PM (GMT 0)
The (lack of) regulations in the law aren't going to guarantee you can keep that policy forever if the insurance company thinks it isn't best for them. You won't lose it because of the ACA.

Insurance companies pretty much can charge anything they want under federal law for individual policies. States sometimes regulate price increases for individual policies. They can get rid of you that way but that is nothing new.

They can discontinue your policy at the end of each year contract but they must make a new policy with similar coverage available unless they stop health insuring in your state and don't return for 5 years. Federal law from awhile back.

Some people lost grandfathered status because the company did the above since 2010 but I can verify that they can do that (or not) after January 1.

Honestly with the ban on preexisting conditions I can't really see why they would want to end grandfathered plans unless they were looking to get out of individual insurance entirely. I am not sure I want to stay on my current plan.

But no you aren't and never were guaranteed a renewal on the same plan or a reasonable price if they did renew.

There is no question that if you leave the grandfathered plan if you can return to it. YOU CAN'T. Sort of a serious decision and it isn't easy to compare a grandfathered plan to the plans on the exchange. Deductible and out of pocket aren't comparable. Coverage is not the same. I am not entirely sure that my plan isn't worse than a bronze plan on the exchange and they have lower premiums.

They way I figure it I wasn't going to be able to stay insured until 65 without healthcare reform. Going up too much, too fast. At least with the reform if I get sick and can't work I can get on medcaid and keep my house and pension. Before in this state, I could be billed to living in the gutter up until age 65.
Posted 10/30/2013 9:18 PM (GMT 0)
I don't watch TV in the daytime, the only news related programs I ever watch are Charlie Rose and the Newshour occasionally on Friday night, and I never watch CNN. Doesn't Rush call that the Communist News Network?

I really looked hard to find something in the ACA that would change a federal employees health insurance plan but I couldn't. What was the CNN story about?
Posted 10/30/2013 10:29 PM (GMT 0)
AZYooper - Numerous stories of people's premiums increasing significantly, their deductibles going up and companies not offering coverages anymore and just dropping people. People have received letters and been told by their insurance companies this is becuase of the ACA.

Insurance companies are a business and they want to make a profit. They are preparing for the unknown with this ACA.
Posted 10/30/2013 10:31 PM (GMT 0)
Premiums are going up because the Affordable Care Act mandates a minimum standard of coverage, so old policies that do not meet the minimum standard of coverage, have to get "new" polices that do provide the minimum standard of coverage, and that minimum standard of coverage in a lot of cases is more expensive than a lot of current catastrophic policies that are affordable.

So, you get better coverage, but you have to pay for it, and it's the Law.

As far as what to do, ask your GI to double your dose and stockpile the extra.

Can you increase your Azathiropine, I know a lot of people controlling their UC with just AZA.
Posted 10/30/2013 10:37 PM (GMT 0)
JHarvey - My policy was more than the minimum standard of coverage by far. My coverage is actually getting worse, not getting better. Like I stated, my premium is going up and my coverage is going down. I wish I was getting better coverage, then it wouldn't be a big deal to me.

My GI told me he wants to eventually just have me on Azathioprine and Remicade. We are tapering me off of Prednisone right now and then I believe he wants to start tapering me off of the AsacolHD as well.

I'm going to do the mail-order at the end of December, so that will take me through March, I still have about an extra month and a half right now so I should be good through mid May. The patent on AsacolHD is up this coming March, I'm hoping the generics will come out quickly. Not sure how long it usually takes for the FDA to approve it and companies to release it.
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