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Can someone tell me if I'm wrong about this: If, when comparing two plans, the difference in annual premium is greater than the difference in out-of-pocket maximum, it will generally (always?) be a better idea to take the cheaper plan. (Assuming networks and such are adequate...which given the state of some companies' provider directories is probably impossible to determine in advance.)
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May 24, 2016 00:37
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VideoTapir posted:Can someone tell me if I'm wrong about this: You're thinking correctly, but in general it depends on the rest of the plan design. The expensive plan might be, e.g., an HMO with low fixed copays with a nominal OOPM that you probably won't ever meet. The cheap plan with a lower OOPM, it might be a high deductible with no coinsurance at all until the OOPM. The minimum and maximum might be better, but in certain utilization scenarios you'd spend some more. If the designs aren't that drastically different, the cheaper plan with relatively low premium is generally the best bet. If you're choosing between employer plans, it could be what some of us in the industry call an "intelligence test" plan.
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May 24, 2016 15:30
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VideoTapir posted:Can someone tell me if I'm wrong about this: This holds true if you are at either end of the spectrum. If you incur no costs in a given year, the cheaper plan has a lower total cost of care (Premium + Out of Pocket), and if you reach your maximum out of pocket the cheaper plan would also have a lower total cost of care. If you fall in the middle, it will just depend on the different benefit designs and what type of claims you have to be able to determine which plan has a lower total cost of care. For example, if we had two plans, one of which you pay 50% out of pocket until you reach a $4,000 max, and one plan where you pay a $3,000 deductible then pay 0 after that, even though their difference in max out of pocket is $1,000, if the 50% coinsurance plan is $1,500 more expensive than the $3,000 deductible plan and you incur $3,000 in claims your total cost of care for each plan is equal $3,000 plan: Pay Premium, + 3000 to meet deductible $4,000 Plan: Pay $1,500 higher premium, but only pay $1,500 in claims Another thing to keep in mind is what type of product it is. There are 2 more popular and 2 less popular products offered: HMO: Requires a gatekeeper PCP that all care goes through, no out-of-network benefits PPO: No gatekeeper required, can see any in-network provider at one set of benefits and any out-of-network provider at reduced benefits POS: Mostly an HMO, requires a gatekeeper PCP that all in-network care goes through, but you can use out-of-network providers at a reduced benefit EPO: Mostly a PPO, no gatekeeper required, can see any in-network provider, no out-of-network benefits Ranked from least to most expensive: HMO POS EPO PPO Reik fucked around with this message at 15:35 on May 25, 2016 |
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May 25, 2016 15:32
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Reik posted:Health insurance companies make money on every age range, not just under fifty. Most business for an insurance company is still through employer sponsored benefit plans which are usually uni-age rated and based on the demographics of the group seeking coverage anyways, which the insurance company has no control over. Having a younger population just means the employer pays a lower premium overall, but it has no affect on the profit margin of the plan. Because profit margins are a percent of total revenue, having an older population which merits higher premiums across the board to cover the higher medical costs actually increases the total profit dollars. If priced appropriately, a sick person that cost twice as much as an average person is effectively two healthy people in terms of revenue. In addition, if you can improve the quality of their care and help sicker people get healthier over the duration of their policy, you end up with higher profits because while they were priced for their health at the policy effective date, but over the duration of the policy they became healthier despite the premiums not going down. If you do this across an entire group, when their group comes up for renewal you would see a premium decrease due to overall health status improving. To be honest, it is probably fair in a sense on a personal level, those people are going to have higher out of pocket costs and putting them on Medicare creates more of a burden for the program but at the same time it likely lessens their own personal expenses. That said, it is a social insurance program designed as a part of the social safety net. As far as expanding Medicare, there is probably issues to iron out but ultimately those 27 year olds will be less sick and will be in effect subsidizing older patients, and at the same time Medicare will have a even stronger ability to negotiation with more members. I believe this was entirely ignored in that study and why it is as politicized as Pravda making an analysis of the American health care system. In fact, most of the numbers they provided were very suspect. The ultimate issue is that of resources and utilizing them in a more efficient manner. You could create an entirely new "public option" but unless it is expansive across the population you aren't going to get the same savings as you would hope. Moreover B/C/D premiums, it will have to be decided what is "fair" to hit younger members of the population considering their income, but that is something that will take an in-depth policy proposal but in essence younger patients will bring over lower subsidies but also have lower expenses [maybe even much lower]. I think the Sandman could have had a more detailed proposal, but the alternative is a ColoradoCare type of program in which a new federal program and Medicare would exist alongside it. If ColoradoCare passes we will see how it fares.
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May 25, 2016 20:44
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Reik posted:
While this is true for the Cigna EPO in my state it should be known that the United Healthcare Compass product that was discontinued in virtually all the states they offered it in did have a gatekeeper for specialists or the plan won't pay. In effect they were running an unregulated HMO by calling their product an EPO.
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May 29, 2016 19:41
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I'm wondering how bad things will get in states, like Oklahoma, where the individual market is down to just one provider. In Oklahoma it's Blue Cross and Blue Shield only. The premiums are insane to get anything that doesn't just immediately have a $6000+ deductible and $12,000 OOPM.
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Jun 4, 2016 19:00
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Ardennes posted:
They would have to be allowed to negotiate in the first place.
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Jun 5, 2016 17:28
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Crashrat posted:I'm wondering how bad things will get in states, like Oklahoma, where the individual market is down to just one provider. In Oklahoma it's Blue Cross and Blue Shield only. The premiums are insane to get anything that doesn't just immediately have a $6000+ deductible and $12,000 OOPM. I know it sounds like insurance company propaganda, but only having one carrier doesn't mean they can just charge whatever they want. The rates filed by BCBSOK still have to be approved by CMS, and as an Actuary that has filed individual health insurance rates to be sold on the exchange, I can say that the CMS does a good job of reviewing the rates. When you negotiate discounts with providers you don't specify which line of business this applies to, so BCBSOK will most likely use this individual market leverage to try and reduce their payments to hospitals to allow them to be more competitive on the small group exchange and with large group employer based coverage. Looking at Oklahoma's plan offerings at https://www.healthcare.gov/see-plans/ their silver level plans for 2016 have deductibles of $3,250 and $3,750, and for these plans you get a couple no charge office visits every year so you do get some first dollar coverage. The $3,750 deductible plan has copays for drug coverage so you don't have to meet the deductible before that benefit kicks in as well.
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Jun 6, 2016 14:58
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http://www.al.com/news/index.ssf/2016/08/blue_cross_proposes_rate_hike_1.html#incart_2box Anyone know much about how this stuff works? Reading that article makes me think Alabama is about to have a major healthcare crisis with most people here not being able to afford healthcare anymore. Earlier this year Humana and United Health left the marketplace and only BCBS is left in the state. I haven't been following much of the Obamacare stuff. Is it expected to fail now? Raccooon fucked around with this message at 21:25 on Aug 8, 2016 |
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Aug 8, 2016 21:21
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Deadulus posted:http://www.al.com/news/index.ssf/2016/08/blue_cross_proposes_rate_hike_1.html#incart_2box So, one thing to keep in mind is people that qualify for a subsidy have a fixed premium based on their income. The amount of the subsidy is the difference in this fixed amount based on income and the second lowest silver plan available in their area, so even if all the rates went up 40%, the subsidy would just grow by that same amount. I personally think the market will stabilize in the next few years and these insurers will return, but I think there has been a lot more focus lately on whether or not employer paid health insurance premiums should be tax deductible, and if they are ruled not tax deductible that would shake up the industry big time.
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Aug 19, 2016 19:34
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Can someone tell me or point me in the right direction as to how the small company I work for can legally reimburse me $250/mo towards my health insurance? I'm the first employee they've hired in over 10 years and nobody knows anything about how this works.
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Aug 22, 2016 20:45
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Mahoning posted:Can someone tell me or point me in the right direction as to how the small company I work for can legally reimburse me $250/mo towards my health insurance? I'm the first employee they've hired in over 10 years and nobody knows anything about how this works. Post-ACA, this type of thing is a minefield with penalties reaching $100/day if they do it incorrectly. It can be done, but you are all better off if they just grossed up your salary.
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Aug 22, 2016 20:58
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esquilax posted:but you are all better off if they just grossed up your salary. Aren't they leaving a tax deduction on the table by doing that?
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Aug 22, 2016 22:19
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PerniciousKnid posted:Aren't they leaving a tax deduction on the table by doing that? Yes, but to set up the arrangement for one or two people, the amount they would pay to a lawyer or third party administrator to ensure the Health Reimbursement Arrangement is compliant with regulations would probably outweigh the tax savings. It would be a major headache for everyone involved. The juice would not be worth the squeeze esquilax fucked around with this message at 22:49 on Aug 22, 2016 |
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Aug 22, 2016 22:47
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Yeah, they could set up a genuine ACA compliant health care plan for everyone, or they could individually increase your pay (perhaps via a bonus). They'll get lower taxes either way because both are legitimate business expenses (employee compensation). The main difference, as far as you are concerned, is the later option would be taxable income to you. Although even then, if you itemize, there might be some kind of tax deduction for medical expenses (I am not an accountant).
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Aug 25, 2016 15:06
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nelson posted:Yeah, they could set up a genuine ACA compliant health care plan for everyone, or they could individually increase your pay (perhaps via a bonus). They'll get lower taxes either way because both are legitimate business expenses (employee compensation). The main difference, as far as you are concerned, is the later option would be taxable income to you. Although even then, if you itemize, there might be some kind of tax deduction for medical expenses (I am not an accountant). Yes, from the company's standpoint they can write off your bumped up wages just the same as they can write off paying you $250 a month. The main differences I see are that the company will be reponsinle for an additional 7.65% of employer side FICA tax for the payment, and for paying additional matching 401k funds and worker's compensation premiums (if applicable and material), and you'll be responsible for paying federal, state, and employee FICA taxes on your end. The company will also be paying extra and receiving no shield from ACA liabilities. I work in management accounting and I am unfamiliar with the personal tax deductions and credits available for you if you buy your own insurance with that money. I am also not licensed or qualified to give tax advice to anyone so take that as you will.
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Sep 8, 2016 17:23
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http://www.foxnews.com/politics/2016/10/24/obama-administration-confirms-double-digit-premium-hikes.htmlquote:Premiums will go up sharply next year under President Barack Obama's health care law, and many consumers will be down to just one insurer, the administration confirmed Monday. That's sure to stoke another "Obamacare" controversy days before a presidential election. quote:The total number of HealthCare.gov insurers will drop from 232 this year to 167 in 2017, a loss of 28 percent. (Insurers are counted multiple times if they offer coverage in more than one state. So Aetna, for example, would count once in each state that it participated in.) Not good. My silver plan is going up $45/month compared to last year. EugeneJ fucked around with this message at 01:00 on Oct 25, 2016 |
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Oct 25, 2016 00:54
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Is there a way to see premium changes against non ACA projection?
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Oct 25, 2016 01:46
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Have you seen my apex seals? I seem to have lost them.
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EugeneJ posted:http://www.foxnews.com/politics/2016/10/24/obama-administration-confirms-double-digit-premium-hikes.html This may be the start of the death spiral as more people will choose to pay the 700 yearly fine than pay so much for insurance. Does anybody know what are the proposed quick fixes for this or will ACA have to be scrapped?
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Oct 25, 2016 01:50
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End the family glitch and remove the employer "affordable" part. Thats a quick start right there. I can't get subsidies for my family of four because the bronze plan is less than 7 percent of my income for one individual. But is un affordable and over 7 percent when I tack on the other 3. My employer doesn't even contribute. I've told my employer about this but they give no shits.
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Oct 25, 2016 01:55
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https://twitter.com/sarahkliff/status/790694227378335745 It's not the death spiral.
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Oct 25, 2016 01:56
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Vladimir Putin posted:Does anybody know what are the proposed quick fixes for this or will ACA have to be scrapped? Hillary supports a vague "public option" at the state level, but she seems to only be encouraging it for people ages 55 and above as a Medicare buy-in. She also wants to add a tax credit where if your medical costs in a given year exceed something like 5% of your income, you get the difference back as a tax credit (up to $2500 maximum). So if 5% of your income is $1000 and your hospital bill is $3000, you can claim a tax credit of $2000 for the year on your next tax return. This would is cost $88 billion dollars to implement. She also wants to fix the "family glitch" so that families aren't stuck with expensive family plans and low subsidies.
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Oct 25, 2016 02:05
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EugeneJ posted:Hillary supports a vague "public option" at the state level, but she seems to only be encouraging it for people ages 55 and above as a Medicare buy-in. Front page of the NY Times: Some Health Plan Costs Will Rise Sharply, U.S. Says quote:"Premiums for midlevel plans under the Affordable Care Act will rise by an average of 25 percent next year, and some consumers will find much fewer insurance options, all but ensuring that the next president will need to alter the health law significantly" http://www.nytimes.com/2016/10/25/u...452D09A&gwt=pay It seems to me like the problem is in the exchanges. In particular too many sick people signed up on the exchanges and not enough healthy people and as a result a bunch of companies lost money and are now leaving markets leaving little to no competition. Clinton accused insurance companies of price gouging, but I don't see how that can be the case since the ACA fixes insurance profits as a certain percentage of premiums, and if they go over, they have to refund the difference to consumers. In the end, I don't think any of the solutions you mentioned is going to address this problem. Vladimir Putin fucked around with this message at 02:42 on Oct 25, 2016 |
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Oct 25, 2016 02:40
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Are these premium raises ever going to taper off? I don't make a lot of money as it is and my monthly savings are getting choked out little by little by the expense. My health care isn't even very good.
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Oct 25, 2016 13:35
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Oxxidation posted:Are these premium raises ever going to taper off? I don't make a lot of money as it is and my monthly savings are getting choked out little by little by the expense. My health care isn't even very good. PPACA says your employer must keep your monthly premiums below 9% of your income, otherwise they're forced to raise your wages whenever the premiums go up or pay a tax penalty since the coverage they offer isn't "affordable" to you They could always just be fuckers and pay a $2000 penalty instead, but likely they'd give you a small raise
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Oct 25, 2016 14:10
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This is also the first year after the risk corridors were gutted. Risk corridors were like reinsurance where companies pay into a pot and anyone with really sick clients drew from the pot. Corridors were different in that you had to have really really sick clients, and the federal government would kick in too. Well republicans called that a bailout and said the market had to stand on its own. They repealed the government contributions in the last budget throwdown. So that's one of the things contributing to the extra sharp increase this year. Oh, it wiped out most of the co-ops too. They couldn't maintain minimum cash reserves after paying out. They took on a lot of sick people at very low prices.
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Oct 25, 2016 14:32
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I think they have to keep the framework of ACA and build on top of it. Scrapping it and coming up with something new is going to be politically insane. They have to tack on fixes that address the problems.
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Oct 26, 2016 02:01
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Only HMO plans left in my market. And I'm a little confused about the wording for seeing a specialist: "You can see the specialist you choose without permission from this plan; however, prior authorization is required from this plan." I'm not even sure what that means. I don't need permission but I do need authorization? Whats the difference?
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Oct 26, 2016 06:40
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Sperg Victorious posted:Only HMO plans left in my market. And I'm a little confused about the wording for seeing a specialist: "You can see the specialist you choose without permission from this plan; however, prior authorization is required from this plan." A wild guess: you need authorization to see a specialist generally, but you don't need permission to choose a specific specialist once you've got the general authorization to see some specialist. Or maybe more likely, if you are given prior authorization, you don't need to get permission every time you see a particular specialist. ComradeCosmobot fucked around with this message at 08:11 on Oct 26, 2016 |
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Oct 26, 2016 08:08
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How is continuity of care handled with so many insurance companies leaving the marketplace? There are real costs to switching doctors, especially for people with complex medical conditions.
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Oct 26, 2016 08:55
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ComradeCosmobot posted:A wild guess: you need authorization to see a specialist generally, but you don't need permission to choose a specific specialist once you've got the general authorization to see some specialist. Just got off the phone with that provider, and the sales agent didn't know the distinction between the two. They tried to transfer me to member services. But member services wouldn't talk to me, since I'm not a member. 
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Oct 26, 2016 15:01
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Vladimir Putin posted:I think they have to keep the framework of ACA and build on top of it. Scrapping it and coming up with something new is going to be politically insane. They have to tack on fixes that address the problems. That's the way it goes with healthcare systems. In the UK, "fixing the NHS" has been top of the agenda politically ever since it was created. Healthcare systems need perpetual fixing to work.
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Oct 26, 2016 15:05
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Konstantin posted:How is continuity of care handled with so many insurance companies leaving the marketplace? There are real costs to switching doctors, especially for people with complex medical conditions. Except for certain HMOs like Kaiser, doctors will generally contract with multiple insurers. A lot of the time, switching health insurance companies does not require you to switch doctors. When people do end up switching doctors, the normal process takes place with medical records being requested and sent over to the new docs.
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Oct 26, 2016 16:56
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esquilax posted:Except for certain HMOs like Kaiser, doctors will generally contract with multiple insurers. A lot of the time, switching health insurance companies does not require you to switch doctors. Most plans, at least on the market place, seem to employ such narrow networks, you shouldn't be surprised if you have to switch doctors. Hell, a last year one of the HMO plans only covered two hospitals, even though there are at least 6 in the area. And of course there was no coverage for out of network providers.
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Oct 26, 2016 19:19
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Sperg Victorious posted:Most plans, at least on the market place, seem to employ such narrow networks, you shouldn't be surprised if you have to switch doctors. Hell, a last year one of the HMO plans only covered two hospitals, even though there are at least 6 in the area. And of course there was no coverage for out of network providers. Next year I either have to switch plans or switch my daughter's pediatrician  The plan is good for hospitals, not so good for independent doctors.
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Oct 26, 2016 19:22
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esquilax posted:Except for certain HMOs like Kaiser, doctors will generally contract with multiple insurers. A lot of the time, switching health insurance companies does not require you to switch doctors. many hmos will also allow you to maintain your outside PCP under many circumstances (too far from their clinics, specialized long-term care, etc) and will only make you stay inside their system for specialists. there are legal standards around transmitting records for CoC purposes too, so if your old provider tries to cockblock your new one they are probably breaking the law. BarbarianElephant posted:Next year I either have to switch plans or switch my daughter's pediatrician that's just the nature of the beast, unfortunately. it's harder for insurers to contract with independent doctors because they don't tend to have actual legal and financial reps to negotiate with the way hospitals and clinics do. small practices tend to have secretarial staff do most of the practice management. doctors will either form associations with larger medical groups or get pushed out of the market. there's upsides and downsides to this in terms of costs and standards compliance, but obviously the optics of it tend to seem pretty bad from the patient's perspective because it's always going to come across as a stealing away of choice. The MUMPSorceress fucked around with this message at 19:31 on Oct 26, 2016 |
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Oct 26, 2016 19:29
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Sperg Victorious posted:Most plans, at least on the market place, seem to employ such narrow networks, you shouldn't be surprised if you have to switch doctors. Hell, a last year one of the HMO plans only covered two hospitals, even though there are at least 6 in the area. And of course there was no coverage for out of network providers. Narrow networks are generally selected in order to contain low-cost or efficient providers. When moving from one narrow network plan to another (like when your exchange plan is eliminated), it's not unlikely that the same providers will show up in both narrow networks. It for sure can affect people, but I don't think the issues in the marketplace are enough to greatly increase the overall numbers from the 5-15% or so churn that you would normally expect to change doctors in a year due to moving/retirement/voluntary provider switches.
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Oct 26, 2016 19:35
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esquilax posted:Narrow networks are generally selected in order to contain low-cost or efficient providers. When moving from one narrow network plan to another (like when your exchange plan is eliminated), it's not unlikely that the same providers will show up in both narrow networks. My old marketplace plan was a national POS. All hospitals in the area covered. Never ran into a problem with going to doctors. The new one I'm likely to get for 2017 is going to be very different. There won't be a single doctor I've visited in the last few years, granted very few, who will be covered under the new network. Besides, with narrow networks you get other problems. There are plenty of stories about people, particularly pregnant women, who can get an in-network doctor, but the hospital is out of network and not covered. Or there will be very few specialists in-network, and you'll be lucky if they happen to be accepting new patients. In the end, it might not matter anyways, since the deductibles/out-of-pocket maximums are so high that you might not be able to afford your care anyways, even if you can find in-network doctors and facilities.
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Oct 27, 2016 00:11
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The 900 lb elephant in the room nobody wants to address is employer paid insurance which contrary to euphoric predictions by guys like ezekiel emanuel shows no signs of collapse. 160 million people are kept out of the ACA pot because they're in an employer self insured or group plan, a group far more likely to be healthier than your average ACA subscriber.
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Nov 1, 2016 05:33
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I'm in Illinois and next year there will be only one PPO available on the marketplace, and it will not cover the largest North-Suburban medical and physician's groups. Other than that, only HMOs.
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Nov 1, 2016 16:46
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