Report your experience with getting insurance via ACA (1 Viewer)

[Foosball God]

Come on now. As a agent/broker you know someone is not going to be able to buy coverage and have it effective "On the way to the hospital".

I get that, and it was an exaggeration, obviously. But what about a woman who's 8 months pregnant? What about someone who's just been diagnosed with something, like cancer? What about someone with an issue they can live with, but would like to have surgically repaired (like a joint replacement)?

There are definitely problems that will arise. And you'll likely hear a lot about them in the early years when the penalties are low. The question will be what the rates look like in a few years when the penalties go up. Then someone will have to revisit the penalty structure as well.

I've said before that I don't think the ACA is the answer, but doing nothing wasn't the answer either. And with things as polarized as they are in today's world I think we have to start something and fix it as we go.

Will that be a lot more painful and expensive than doing the right thing up front, of course. But we'll never do the right thing up front the way things are now.

 

[tri-man 47]

Chicago Tribune did some research on costs and it wasn't pretty. Most Illinois plans have deductibles exceeding $4,000 (indiv) and $8,000 (family). Many of the new plans have deductibles of $12,700. Those numbers represent a really big chunk of change on top of premiums that tend to be higher than existing plans. The Trib was not impressed.

 

[Foosball God]

Currently paying ~$100/month for an HDHP + HRA (pretty awesome really) with a $1,600 deductible. In my 30s, non-smoker.

For that same price I can get an HDHP + HSA with a $3,500 deductible "pre-Obamacare".

For $234/month I can get an HDHP + HSA with a $3650 deductible silver plan "post-Obamacare".

So twice the premium for twice the deductible. Got it.

I think he was saying he was getting those deals through his company. The bottom two are what you should focus on. Over twice the premium but the deductible is up "only" $150.

Still not great.

 

[Jojo the circus boy]

Currently paying ~$100/month for an HDHP + HRA (pretty awesome really) with a $1,600 deductible. In my 30s, non-smoker.

For that same price I can get an HDHP + HSA with a $3,500 deductible "pre-Obamacare".

For $234/month I can get an HDHP + HSA with a $3650 deductible silver plan "post-Obamacare".

So twice the premium for twice the deductible. Got it.

I think he was saying he was getting those deals through his company. The bottom two are what you should focus on. Over twice the premium but the deductible is up "only" $150.Still not great.

Premium is still more than double.

 

[boubucarow]

Currently paying ~$100/month for an HDHP + HRA (pretty awesome really) with a $1,600 deductible. In my 30s, non-smoker.

For that same price I can get an HDHP + HSA with a $3,500 deductible "pre-Obamacare".

For $234/month I can get an HDHP + HSA with a $3650 deductible silver plan "post-Obamacare".

So twice the premium for twice the deductible. Got it.

I think he was saying he was getting those deals through his company. The bottom two are what you should focus on. Over twice the premium but the deductible is up "only" $150.Still not great.

Premium is still more than double.

I think it is the premium times two.

 

[matttyl]

Anyone else want to share what they found for their rates on ehealth.com - both for what's available today in 2013 and what options you'll have next year?

 

[Schlzm]

Anyone else want to share what they found for their rates on ehealth.com - both for what's available today in 2013 and what options you'll have next year?

Horrible is what they are.

pre: Lowest = $193.25/mo, $25 copay, $10,00 deductible.

Highest = $600.62/mo, $20 copay, $1,000 deductible.

post: Lowest = $437.78/mo, $45 copay, $12,700 deductible.

Highest = $763.74/mo, $10 copay, $4,500 deductible.

Schlzm

 

[MaxThreshold]

Anyone else want to share what they found for their rates on ehealth.com - both for what's available today in 2013 and what options you'll have next year?

Horrible is what they are.

pre: Lowest = $193.25/mo, $25 copay, $10,00 deductible.

Highest = $600.62/mo, $20 copay, $1,000 deductible.

post: Lowest = $437.78/mo, $45 copay, $12,700 deductible.

Highest = $763.74/mo, $10 copay, $4,500 deductible.

Schlzm

Waiting for the inevitable "Obamacare is not designed for people like you so that's too bad" post.

 

[matttyl]

There are definitely problems that will arise. And you'll likely hear a lot about them in the early years when the penalties are low. The question will be what the rates look like in a few years when the penalties go up. Then someone will have to revisit the penalty structure as well.

These "problems" though, are what will make the rates a few years from now be even more atrocious. Currently the math is something like the top 3-5% of insureds have between 50-80% of the total claims. If we're now going to allow these huge claims to be not just the top 3-5%, but rather the top 10-15% because of guaranteed issue and no pre-ex, claims will be 2-3x as high as they are now and premiums will have to rise high enough to offset that. I just don't see that many more "healthy people" jumping in to offset all the sick that will do this, or all the sick that will have coverage for a full year (not game the system) but still have all of their claims covered.

In a few years when the individual rates are 40-50% higher than these 2014 rates being quoted, even 2.5% of income (or whatever it will be at that time) will be much smaller and likely "worth it" for many.

 

[MaxThreshold]

There are definitely problems that will arise. And you'll likely hear a lot about them in the early years when the penalties are low. The question will be what the rates look like in a few years when the penalties go up. Then someone will have to revisit the penalty structure as well.

These "problems" though, are what will make the rates a few years from now be even more atrocious. Currently the math is something like the top 3-5% of insureds have between 50-80% of the total claims. If we're now going to allow these huge claims to be not just the top 3-5%, but rather the top 10-15% because of guaranteed issue and no pre-ex, claims will be 2-3x as high as they are now and premiums will have to rise high enough to offset that. I just don't see that many more "healthy people" jumping in to offset all the sick that will do this, or all the sick that will have coverage for a full year (not game the system) but still have all of their claims covered.

In a few years when the individual rates are 40-50% higher than these 2014 rates being quoted, even 2.5% of income (or whatever it will be at that time) will be much smaller and likely "worth it" for many.

Mattyl - you're providing top quality posts in here. With your inside knowledge it's hard to believe anyone could dispute you, although I know a bunch have tried and failed miserably. Keep up the good work trying to enlighten people on he facts.

 

[Foosball God]

There are definitely problems that will arise. And you'll likely hear a lot about them in the early years when the penalties are low. The question will be what the rates look like in a few years when the penalties go up. Then someone will have to revisit the penalty structure as well.

These "problems" though, are what will make the rates a few years from now be even more atrocious. Currently the math is something like the top 3-5% of insureds have between 50-80% of the total claims. If we're now going to allow these huge claims to be not just the top 3-5%, but rather the top 10-15% because of guaranteed issue and no pre-ex, claims will be 2-3x as high as they are now and premiums will have to rise high enough to offset that. I just don't see that many more "healthy people" jumping in to offset all the sick that will do this, or all the sick that will have coverage for a full year (not game the system) but still have all of their claims covered.

In a few years when the individual rates are 40-50% higher than these 2014 rates being quoted, even 2.5% of income (or whatever it will be at that time) will be much smaller and likely "worth it" for many.

That is going to be unsustainable though. There is going to have to be a correction somewhere.

 

[Abraham]

When I had my business I paid $590/month for me, wife and kid. 10k individual deductible, 5k separate maternity deductible, all office visits out of pocket until deductible was met. Just ran a check on eHealth and there are MUCH better plans for less money.

 

[Henry Ford]

When I had my business I paid $590/month for me, wife and kid. 10k individual deductible, 5k separate maternity deductible, all office visits out of pocket until deductible was met. Just ran a check on eHealth and there are MUCH better plans for less money.

Yeah. I just found a $300/month for myself with $1,800 deductible, $5,300 out of pocket max, $25 doctor visits and $3 generics. E.R. and in-hospital co-pays suck, but not much worse than most insurance plans set up with mostly co-pays instead of deductible-related items.

 

[Statorama]

Daily Kos blogger weighs in

My wife and I just got our updates from Kaiser telling us what our 2014 rates will be. Her monthly has been $168 this year, mine $150. We have a high deductible.

We are generally healthy people who don't go to the doctor often. I barely ever go. The insurance is in case of a major catastrophe.

Well, now, because of Obamacare, my wife's rate is gong to $302 per month and mine is jumping to $284.

I am canceling insurance for us and I am not paying any ####### penalty. What the hell kind of reform is this?

Oh, ok, if we qualify, we can get some government assistance. Great. So now I have to jump through another hoop to just chisel some of this off. And we don't qualify, anyway, so what's the point?

I never felt too good about how this was passed and what it entailed, but I figured if it saved Americans money, I could go along with it.

I don't know what to think now. This appears, in my experience, to not be a reform for the people.

What am I missing?

 

[Statorama]

Chicago Tribune did some research on costs and it wasn't pretty. Most Illinois plans have deductibles exceeding $4,000 (indiv) and $8,000 (family). Many of the new plans have deductibles of $12,700. Those numbers represent a really big chunk of change on top of premiums that tend to be higher than existing plans. The Trib was not impressed.

What are "things I could have told the Chicago Tribune back in 2009" Alex.

Broken promises of Obamacare for $200 please. DAILY DOUBLE!

 

[matttyl]

Mattyl - you're providing top quality posts in here. With your inside knowledge it's hard to believe anyone could dispute you, although I know a bunch have tried and failed miserably. Keep up the good work trying to enlighten people on he facts.

Really, thank you for that. I'm doing what I can to educate myself on the subject....I have to as it's my job, and I hope I've done some good to educate others on the subject as well.

 

[matttyl]

There are definitely problems that will arise. And you'll likely hear a lot about them in the early years when the penalties are low. The question will be what the rates look like in a few years when the penalties go up. Then someone will have to revisit the penalty structure as well.

These "problems" though, are what will make the rates a few years from now be even more atrocious. Currently the math is something like the top 3-5% of insureds have between 50-80% of the total claims. If we're now going to allow these huge claims to be not just the top 3-5%, but rather the top 10-15% because of guaranteed issue and no pre-ex, claims will be 2-3x as high as they are now and premiums will have to rise high enough to offset that. I just don't see that many more "healthy people" jumping in to offset all the sick that will do this, or all the sick that will have coverage for a full year (not game the system) but still have all of their claims covered.

In a few years when the individual rates are 40-50% higher than these 2014 rates being quoted, even 2.5% of income (or whatever it will be at that time) will be much smaller and likely "worth it" for many.

That is going to be unsustainable though. There is going to have to be a correction somewhere.

And what would you like that to be? Seriously? Either you take away guaranteed issue, or you take away the no pre-ex limitation.

Currently carriers with individual contracts have a "6 month waiting period" prior to CONCEPTION for their maternity rider. That means that someone purchasing an individual policy would have to include this rider, and have both intact for both that 6 month waiting period at least - followed by the ~9 month term of the baby (so I minimum of 15 months of premium to the carrier). Even with that the insurance company was still losing money because your average delivery today is five figures. Telling a woman she can purchase coverage at any time, and that delivery will be covered will be horrible for claims.

Why is a 6 month waiting period for situations like that such a bad thing? But NNNNOOOOO....we can't have any pre-existing condition limitations now can we?

 

[matttyl]

When I had my business I paid $590/month for me, wife and kid. 10k individual deductible, 5k separate maternity deductible, all office visits out of pocket until deductible was met. Just ran a check on eHealth and there are MUCH better plans for less money.

Yeah. I just found a $300/month for myself with $1,800 deductible, $5,300 out of pocket max, $25 doctor visits and $3 generics. E.R. and in-hospital co-pays suck, but not much worse than most insurance plans set up with mostly co-pays instead of deductible-related items.

And what plans could you have today?

 

[Henry Ford]

When I had my business I paid $590/month for me, wife and kid. 10k individual deductible, 5k separate maternity deductible, all office visits out of pocket until deductible was met. Just ran a check on eHealth and there are MUCH better plans for less money.

Yeah. I just found a $300/month for myself with $1,800 deductible, $5,300 out of pocket max, $25 doctor visits and $3 generics. E.R. and in-hospital co-pays suck, but not much worse than most insurance plans set up with mostly co-pays instead of deductible-related items.

And what plans could you have today?

Without employment-based insurance?

 

[matttyl]

When I had my business I paid $590/month for me, wife and kid. 10k individual deductible, 5k separate maternity deductible, all office visits out of pocket until deductible was met. Just ran a check on eHealth and there are MUCH better plans for less money.

Yeah. I just found a $300/month for myself with $1,800 deductible, $5,300 out of pocket max, $25 doctor visits and $3 generics. E.R. and in-hospital co-pays suck, but not much worse than most insurance plans set up with mostly co-pays instead of deductible-related items.

And what plans could you have today?

Without employment-based insurance?

Yes. You're quoting individual ACA (2014) plans. Why don't you also quote a comparable 2013 individual plan available to you?

If you just tell me your zip code and age I'd be happy to do it for you.

 

[TheIronSheik]

When I had my business I paid $590/month for me, wife and kid. 10k individual deductible, 5k separate maternity deductible, all office visits out of pocket until deductible was met. Just ran a check on eHealth and there are MUCH better plans for less money.

Yeah. I just found a $300/month for myself with $1,800 deductible, $5,300 out of pocket max, $25 doctor visits and $3 generics. E.R. and in-hospital co-pays suck, but not much worse than most insurance plans set up with mostly co-pays instead of deductible-related items.

And what plans could you have today?

Without employment-based insurance?

Yes. You're quoting individual ACA (2014) plans. Why don't you also quote a comparable 2013 individual plan available to you?

If you just tell me your zip code and age I'd be happy to do it for you.

If you give me your Mother's maiden name and SS#, I can do it faster.

 

[Henry Ford]

When I had my business I paid $590/month for me, wife and kid. 10k individual deductible, 5k separate maternity deductible, all office visits out of pocket until deductible was met. Just ran a check on eHealth and there are MUCH better plans for less money.

Yeah. I just found a $300/month for myself with $1,800 deductible, $5,300 out of pocket max, $25 doctor visits and $3 generics. E.R. and in-hospital co-pays suck, but not much worse than most insurance plans set up with mostly co-pays instead of deductible-related items.

And what plans could you have today?

Without employment-based insurance?

Yes. You're quoting individual ACA (2014) plans. Why don't you also quote a comparable 2013 individual plan available to you?

If you just tell me your zip code and age I'd be happy to do it for you.

The problem is, I fit into an interesting exclusive Pre-Existing Condition club filled with unbelievably healthy people. Finding insurance isn't just "what does the plan normally cost" but rather "what does the plan cost when you have an idiotic pre-existing condition." I found a policy several years ago which would cover me at about $700 a month. I think that's the best I found. So $300 a month for solid insurance makes heading out and starting my firm actually viable within the next couple of years.

 

[BassNBrew]

mattyl - Can you help me out with a subsidy question? BCBS is asking for the number of dependents to calculate my subsidy. My ex- claims my child on the tax return so he's her "dependent" there, I pay for his insurance so he's my "dependent" on the plan. There aren't any instructions explaining this. Should I just say two and let BCBS and the gov't sort it out later if it's wrong?

 

[Foosball God]

There are definitely problems that will arise. And you'll likely hear a lot about them in the early years when the penalties are low. The question will be what the rates look like in a few years when the penalties go up. Then someone will have to revisit the penalty structure as well.

These "problems" though, are what will make the rates a few years from now be even more atrocious. Currently the math is something like the top 3-5% of insureds have between 50-80% of the total claims. If we're now going to allow these huge claims to be not just the top 3-5%, but rather the top 10-15% because of guaranteed issue and no pre-ex, claims will be 2-3x as high as they are now and premiums will have to rise high enough to offset that. I just don't see that many more "healthy people" jumping in to offset all the sick that will do this, or all the sick that will have coverage for a full year (not game the system) but still have all of their claims covered.

In a few years when the individual rates are 40-50% higher than these 2014 rates being quoted, even 2.5% of income (or whatever it will be at that time) will be much smaller and likely "worth it" for many.

That is going to be unsustainable though. There is going to have to be a correction somewhere.

And what would you like that to be? Seriously? Either you take away guaranteed issue, or you take away the no pre-ex limitation.

Currently carriers with individual contracts have a "6 month waiting period" prior to CONCEPTION for their maternity rider. That means that someone purchasing an individual policy would have to include this rider, and have both intact for both that 6 month waiting period at least - followed by the ~9 month term of the baby (so I minimum of 15 months of premium to the carrier). Even with that the insurance company was still losing money because your average delivery today is five figures. Telling a woman she can purchase coverage at any time, and that delivery will be covered will be horrible for claims.

Why is a 6 month waiting period for situations like that such a bad thing? But NNNNOOOOO....we can't have any pre-existing condition limitations now can we?

I don't think denying people coverage because they have cancer or something is a good idea. There can and should be limitations in place to stop people from gaming the system as in the case of not being insured and then getting coverage just because you are sick, or pregnant.

As an agent, did you really think the status quo was working?

 

[Schlzm]

Anyone else want to share what they found for their rates on ehealth.com - both for what's available today in 2013 and what options you'll have next year?

Horrible is what they are.pre: Lowest = $193.25/mo, $25 copay, $10,00 deductible.

Highest = $600.62/mo, $20 copay, $1,000 deductible.

post: Lowest = $437.78/mo, $45 copay, $12,700 deductible.

Highest = $763.74/mo, $10 copay, $4,500 deductible.

Schlzm

Waiting for the inevitable "Obamacare is not designed for people like you so that's too bad" post.

Looks like you headed it off at the pass instead.Schlzm

 

[matttyl]

mattyl - Can you help me out with a subsidy question? BCBS is asking for the number of dependents to calculate my subsidy. My ex- claims my child on the tax return so he's her "dependent" there, I pay for his insurance so he's my "dependent" on the plan. There aren't any instructions explaining this. Should I just say two and let BCBS and the gov't sort it out later if it's wrong?

Wow, I'm getting asked for help!

I'd love to help, but I'm not an accountant or lawyer. I'm on the insurance side of things, so I really don't know the inner workings of the subsidy.

That said, since the child is claimed on your ex's taxes, I would say that she's not a dependent of yours for the subsidy. Your dependents should be what your file on your taxes, at least that is my understanding.

 

[matttyl]

I don't think denying people coverage because they have cancer or something is a good idea. There can and should be limitations in place to stop people from gaming the system as in the case of not being insured and then getting coverage just because you are sick, or pregnant.

As an agent, did you really think the status quo was working?

If you're asking me "as an agent" did the status quo of health insurance work....

In many cases, yes I did. I say that honestly. But at the same time people need to understand how that industry works, and that's my job. Most people have coverage options, and I say that knowing that some options aren't affordable.....but then again so could be going without coverage altogether. Many states have what's called a "carrier of last resorts" which will allow someone to obtain a (typically very expensive) policy and have coverage. Between HIPAA and COBRA, anyone who's every been on an employer based plan has had the right to continuous coverage without any pre-ex limits or anything like that. If people always had coverage ("continuous coverage" meaning no more than a 63 day break) they'd never have any issue with pre-ex limits. And if people had coverage "before the storm", then they wouldn't be rated up on an existing policy after they get sick (carriers CAN NOT raise rates on existing contracts because the person had high claims).

If you're asking me "as an agent" did the status quo of health care costs work....obviously not.

Those are not the same. Health insurance costs are only what they are because health care costs are what they are.

 

[TheIronSheik]

Serious question:

Can insurance companies still say no to certain meds with this new bill? I know things like Celebrex was always a no go on past insurances for me. Any chance this is changing?

 

[matttyl]

Serious question:

Can insurance companies still say no to certain meds with this new bill? I know things like Celebrex was always a no go on past insurances for me. Any chance this is changing?

Not sure, but likely no. Your cost will depend on what "tier" the drug is on with whatever coverage you have - meaning it could be tier 1 with one carrier and you pay $15 and it be tier 2 with a different carrier and you pay $40.

 

[TheIronSheik]

Serious question:

Can insurance companies still say no to certain meds with this new bill? I know things like Celebrex was always a no go on past insurances for me. Any chance this is changing?

Not sure, but likely no. Your cost will depend on what "tier" the drug is on with whatever coverage you have - meaning it could be tier 1 with one carrier and you pay $15 and it be tier 2 with a different carrier and you pay $40.

Hmmm.... seems like that should have been as important as not denying for pre-existing conditions. I hate that I have insurance but the insurance company is like, "Oh. That med? No. You can't have that med."

 

[matttyl]

Serious question:

Can insurance companies still say no to certain meds with this new bill? I know things like Celebrex was always a no go on past insurances for me. Any chance this is changing?

Not sure, but likely no. Your cost will depend on what "tier" the drug is on with whatever coverage you have - meaning it could be tier 1 with one carrier and you pay $15 and it be tier 2 with a different carrier and you pay $40.

Hmmm.... seems like that should have been as important as not denying for pre-existing conditions. I hate that I have insurance but the insurance company is like, "Oh. That med? No. You can't have that med."

Not familiar with the drug, but does it have a generic version? What's it for?

And I meant "no, they can't still say no to certain meds".

 

[Foosball God]

The issuer has to submit a drug formulary and it has to have a certain amount of drugs per tier. They can meet that mandate and still exclude certain drugs.

 

[Schlzm]

The issuer has to submit a drug formulary and it has to have a certain amount of drugs per tier. They can meet that mandate and still exclude certain drugs.

Does the tiering system within the ACA have any affect on non provider prescription drug programs, such as WalMarts 7$ generics program?Schlzm

 

[Ministry of Pain]

Currently paying ~$100/month for an HDHP + HRA (pretty awesome really) with a $1,600 deductible. In my 30s, non-smoker.

For that same price I can get an HDHP + HSA with a $3,500 deductible "pre-Obamacare".

For $234/month I can get an HDHP + HSA with a $3650 deductible silver plan "post-Obamacare".

So twice the premium for twice the deductible. Got it.

Matty deserves recognition for keeping the train on the track.

 

[TheIronSheik]

Serious question:

Can insurance companies still say no to certain meds with this new bill? I know things like Celebrex was always a no go on past insurances for me. Any chance this is changing?

Not sure, but likely no. Your cost will depend on what "tier" the drug is on with whatever coverage you have - meaning it could be tier 1 with one carrier and you pay $15 and it be tier 2 with a different carrier and you pay $40.

Hmmm.... seems like that should have been as important as not denying for pre-existing conditions. I hate that I have insurance but the insurance company is like, "Oh. That med? No. You can't have that med."

Not familiar with the drug, but does it have a generic version? What's it for?

And I meant "no, they can't still say no to certain meds".

Celebrex is a arthritis medication. There is no generic for Celebrex.

 

[Foosball God]

The issuer has to submit a drug formulary and it has to have a certain amount of drugs per tier. They can meet that mandate and still exclude certain drugs.

Does the tiering system within the ACA have any affect on non provider prescription drug programs, such as WalMarts 7$ generics program?Schlzm

No, the drug tiering system has been in place for years. If there is a change to a pharmacy's generic program it won't be because of that.

 

[Keerock]

Anyone else want to share what they found for their rates on ehealth.com - both for what's available today in 2013 and what options you'll have next year?

Horrible is what they are.

pre: Lowest = $193.25/mo, $25 copay, $10,00 deductible.

Highest = $600.62/mo, $20 copay, $1,000 deductible.

post: Lowest = $437.78/mo, $45 copay, $12,700 deductible.

Highest = $763.74/mo, $10 copay, $4,500 deductible.

Schlzm

Waiting for the inevitable "Obamacare is not designed for people like you so that's too bad" post.

Maybe I'm missing something. I currently pay ~$250 per month through my employer for a family plan with a $3K deductible. eHealth.com is telling me the best price for a 'similar' plan for 2014 would cost me about $1,500 per month. If that's the case, and my employer drops my health care coverage, I'm ####ed!

 

[matttyl]

Maybe I'm missing something. I currently pay ~$250 per month through my employer for a family plan with a $3K deductible. eHealth.com is telling me the best price for a 'similar' plan for 2014 would cost me about $1,500 per month. If that's the case, and my employer drops my health care coverage, I'm ####ed!

Nope, you're not missing anything. Your employer is likely greatly subsidizing your coverage, which is why your current coverage is costing you so little (but possibly costing your employer a whole lot, possibly even more than $1,500).

 

[TheIronSheik]

Anyone else want to share what they found for their rates on ehealth.com - both for what's available today in 2013 and what options you'll have next year?

Horrible is what they are.

pre: Lowest = $193.25/mo, $25 copay, $10,00 deductible.

Highest = $600.62/mo, $20 copay, $1,000 deductible.

post: Lowest = $437.78/mo, $45 copay, $12,700 deductible.

Highest = $763.74/mo, $10 copay, $4,500 deductible.

Schlzm

Waiting for the inevitable "Obamacare is not designed for people like you so that's too bad" post.

Maybe I'm missing something. I currently pay ~$250 per month through my employer for a family plan with a $3K deductible. eHealth.com is telling me the best price for a 'similar' plan for 2014 would cost me about $1,500 per month. If that's the case, and my employer drops my health care coverage, I'm ####ed!

Yikes. That's a scary thought. That's an insane jump.

 

[Deranged Hermit]

Serious question:

Can insurance companies still say no to certain meds with this new bill? I know things like Celebrex was always a no go on past insurances for me. Any chance this is changing?

Not sure, but likely no. Your cost will depend on what "tier" the drug is on with whatever coverage you have - meaning it could be tier 1 with one carrier and you pay $15 and it be tier 2 with a different carrier and you pay $40.

Hmmm.... seems like that should have been as important as not denying for pre-existing conditions. I hate that I have insurance but the insurance company is like, "Oh. That med? No. You can't have that med."

Not familiar with the drug, but does it have a generic version? What's it for?

And I meant "no, they can't still say no to certain meds".

Celebrex is a arthritis medication. There is no generic for Celebrex.

In the past, I've been able to get around that by having my PCP send a letter to the insurance company saying the drug was 'medically necessary'. A seizure med I have was not covered by insurance but it is now because of that loophole. Yeah, I pay in the highest tier of co-pay, but it's better than the alternative.

 

[tom22406]

Anyone else want to share what they found for their rates on ehealth.com - both for what's available today in 2013 and what options you'll have next year?

Horrible is what they are.

pre: Lowest = $193.25/mo, $25 copay, $10,00 deductible.

Highest = $600.62/mo, $20 copay, $1,000 deductible.

post: Lowest = $437.78/mo, $45 copay, $12,700 deductible.

Highest = $763.74/mo, $10 copay, $4,500 deductible.

Schlzm

Waiting for the inevitable "Obamacare is not designed for people like you so that's too bad" post.

Maybe I'm missing something. I currently pay ~$250 per month through my employer for a family plan with a $3K deductible. eHealth.com is telling me the best price for a 'similar' plan for 2014 would cost me about $1,500 per month. If that's the case, and my employer drops my health care coverage, I'm ####ed!

Yikes. That's a scary thought. That's an insane jump.

I am having this happen to me right now with my employer dropping coverage and me not qualifying for a subsidy and I will assume that those of us that are losing insurance through our employer and not qualifying for the subsidy are going to see a huge sticker shock.

Maybe mattyl can help explain this more but I believe that is what will happen.

 

[matttyl]

I am having this happen to me right now with my employer dropping coverage and me not qualifying for a subsidy and I will assume that those of us that are losing insurance through our employer and not qualifying for the subsidy are going to see a huge sticker shock.

Maybe mattyl can help explain this more but I believe that is what will happen.

No, you've got it right. I assume your employer is going to drop coverage at the end of the year?

Many employers *could* drop coverage all together, "force" employees onto these exchanges, pay the employee what their cost on the exchange would be and still be in the green (maybe by a little, maybe by a lot....especially if the employees are getting subsidies which apparently you aren't). Employers, though, are unlikely to just give all the money they "saved" by canceling the group policy right back to the employees.

Tom, does your spouse have employer group coverage available?

 

[tom22406]

I am having this happen to me right now with my employer dropping coverage and me not qualifying for a subsidy and I will assume that those of us that are losing insurance through our employer and not qualifying for the subsidy are going to see a huge sticker shock.

Maybe mattyl can help explain this more but I believe that is what will happen.

No, you've got it right. I assume your employer is going to drop coverage at the end of the year?

Many employers *could* drop coverage all together, "force" employees onto these exchanges, pay the employee what their cost on the exchange would be and still be in the green (maybe by a little, maybe by a lot....especially if the employees are getting subsidies which apparently you aren't). Employers, though, are unlikely to just give all the money they "saved" by canceling the group policy right back to the employees.

Tom, does your spouse have employer group coverage available?

Yes my employer is dropping coverage at the end of the year and in return has taken some of the savings they will be getting by not having to provide insurance into a higher wage pay for each employee so that does help.And no to your second question.

 

[BassNBrew]

I am having this happen to me right now with my employer dropping coverage and me not qualifying for a subsidy and I will assume that those of us that are losing insurance through our employer and not qualifying for the subsidy are going to see a huge sticker shock.

Maybe mattyl can help explain this more but I believe that is what will happen.

No, you've got it right. I assume your employer is going to drop coverage at the end of the year?

Many employers *could* drop coverage all together, "force" employees onto these exchanges, pay the employee what their cost on the exchange would be and still be in the green (maybe by a little, maybe by a lot....especially if the employees are getting subsidies which apparently you aren't). Employers, though, are unlikely to just give all the money they "saved" by canceling the group policy right back to the employees.

Tom, does your spouse have employer group coverage available?

Yes my employer is dropping coverage at the end of the year and in return has taken some of the savings they will be getting by not having to provide insurance into a higher wage pay for each employee so that does help.And no to your second question.

But if you like your current plan you can keep it.

I hope the wage bump covers you premium expense.

 

[matttyl]

I am having this happen to me right now with my employer dropping coverage and me not qualifying for a subsidy and I will assume that those of us that are losing insurance through our employer and not qualifying for the subsidy are going to see a huge sticker shock.

Maybe mattyl can help explain this more but I believe that is what will happen.

No, you've got it right. I assume your employer is going to drop coverage at the end of the year?

Many employers *could* drop coverage all together, "force" employees onto these exchanges, pay the employee what their cost on the exchange would be and still be in the green (maybe by a little, maybe by a lot....especially if the employees are getting subsidies which apparently you aren't). Employers, though, are unlikely to just give all the money they "saved" by canceling the group policy right back to the employees.

Tom, does your spouse have employer group coverage available?

Yes my employer is dropping coverage at the end of the year and in return has taken some of the savings they will be getting by not having to provide insurance into a higher wage pay for each employee so that does help.And no to your second question.

Ok, so if neither of you have access to group coverage come Jan 1, then your subsidy eligibility should rely solely on your income (which apparently will be increasing a bit), and if your income compared to family size is within 400% of the FPL. Have you run a quote on ehealth for what a plan would cost you and your family unsubsidized?

 

[Mr Two Cents]

When I had my business I paid $590/month for me, wife and kid. 10k individual deductible, 5k separate maternity deductible, all office visits out of pocket until deductible was met. Just ran a check on eHealth and there are MUCH better plans for less money.

Yeah. I just found a $300/month for myself with $1,800 deductible, $5,300 out of pocket max, $25 doctor visits and $3 generics. E.R. and in-hospital co-pays suck, but not much worse than most insurance plans set up with mostly co-pays instead of deductible-related items.

Link please, I still need insurance. This is way better than most .

 

[Henry Ford]

When I had my business I paid $590/month for me, wife and kid. 10k individual deductible, 5k separate maternity deductible, all office visits out of pocket until deductible was met. Just ran a check on eHealth and there are MUCH better plans for less money.

Yeah. I just found a $300/month for myself with $1,800 deductible, $5,300 out of pocket max, $25 doctor visits and $3 generics. E.R. and in-hospital co-pays suck, but not much worse than most insurance plans set up with mostly co-pays instead of deductible-related items.

Link please, I still need insurance. This is way better than most .

Plans are different in every state. You'll have to look through your state's options.

 

[matttyl]

When I had my business I paid $590/month for me, wife and kid. 10k individual deductible, 5k separate maternity deductible, all office visits out of pocket until deductible was met. Just ran a check on eHealth and there are MUCH better plans for less money.

Yeah. I just found a $300/month for myself with $1,800 deductible, $5,300 out of pocket max, $25 doctor visits and $3 generics. E.R. and in-hospital co-pays suck, but not much worse than most insurance plans set up with mostly co-pays instead of deductible-related items.

Link please, I still need insurance. This is way better than most .

Plans are different in every state. You'll have to look through your state's options.

And even this plan would cost Henry Ford $3,600 a year plus another $1,800 in deductible should anything happen. As this is "standardized" for anyone in his (area of his) state, it's the same rate for anyone his age for that plan.

 

[Henry Ford]

When I had my business I paid $590/month for me, wife and kid. 10k individual deductible, 5k separate maternity deductible, all office visits out of pocket until deductible was met. Just ran a check on eHealth and there are MUCH better plans for less money.

Yeah. I just found a $300/month for myself with $1,800 deductible, $5,300 out of pocket max, $25 doctor visits and $3 generics. E.R. and in-hospital co-pays suck, but not much worse than most insurance plans set up with mostly co-pays instead of deductible-related items.

Link please, I still need insurance. This is way better than most .

Plans are different in every state. You'll have to look through your state's options.

And even this plan would cost Henry Ford $3,600 a year plus another $1,800 in deductible should anything happen. As this is "standardized" for anyone in his (area of his) state, it's the same rate for anyone his age for that plan.

Yes, but, for generally covered services - like doctor's appointments, medications, etc., there is no deductible - only co-pays.

 

[matttyl]

When I had my business I paid $590/month for me, wife and kid. 10k individual deductible, 5k separate maternity deductible, all office visits out of pocket until deductible was met. Just ran a check on eHealth and there are MUCH better plans for less money.

Yeah. I just found a $300/month for myself with $1,800 deductible, $5,300 out of pocket max, $25 doctor visits and $3 generics. E.R. and in-hospital co-pays suck, but not much worse than most insurance plans set up with mostly co-pays instead of deductible-related items.

Link please, I still need insurance. This is way better than most .

Plans are different in every state. You'll have to look through your state's options.

And even this plan would cost Henry Ford $3,600 a year plus another $1,800 in deductible should anything happen. As this is "standardized" for anyone in his (area of his) state, it's the same rate for anyone his age for that plan.

Yes, but, for generally covered services - like doctor's appointments, medications, etc., there is no deductible - only co-pays.

Oh I get that completely. My point is that $3,600 is quite a lot when compared to options many have today.