Bizarre nightmare or 11-dimensional chess re: PPACA/Obamacare

[ReverendDeuce]

I'll make it brief. I've always been skeptical of Obamacare but never really against it... until now.

I carry an individual insurance policy through Blue Cross. I pay $153/mo, have a $1,500 deductible, $1,500 out-of-pocket limit, and a 0% copay.

I got my PPACA packet from Blue Cross/Blue Shield outlining my new plan which is "ACA compatible," and the sum-of-all-fears reality is that my new "compatible" plan is $264, with a $3,000 deductible, $6,350 out-of-pocket limit, and a whopping 50% copay! I am forced into it on January 1st because they can no longer sell my old plan.

Are the insurance companies are being spiteful and vindictive? Is this some 11-dimensional Obama plan to get single-payer? Because this looks bloody awful...

[Suburban Warrior]

1. Shop around in your state's health care exchange starting October 1.

You will most likely find a cheaper policy with better coverage.

[dkf]

2. Obama promised no changes in current policies.

Yeah maybe the OP can get a cheaper policy, but the trust will be gone.

[ReverendDeuce]

4. I don't think he ever said no changes to policies...

Just that you can "keep your current doctor", assuming you stay with your current plan... thus you'll still have the same insurance company... etc.

[dkf]

5. Oh yes he did.

For those Americans who already have health insurance, the only changes you will see under the law are new benefits, better protections from insurance company abuses, and more value for every dollar you spend on health care. If you like your plan you can keep it and you don’t have to change a thing due to the health care law.

http://m.whitehouse.gov/healthreform/healthcare-overview

[sobenji]

27. Minimum benefits

He is seeing an increased premium from minimum required benefits

[dkf]

36. Which people are thrilled with because they think its "free".

[ReverendDeuce]

41. But I don't need pediatric dental or vision... I am in my mid 30s!

Nor do I need maternity coverage.

I get the idea of spreading the risk around, but these "essential benefits" make no sense for me.

[sobenji]

49. Vision and dental for adults are not essential health benefits

And even if you don't need maternity coverage, it's illegal to discriminate based on gender.

"s. Essential health benefits must include items and services within at least the following 10 categories: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care."

From https://www.healthcare.gov/glossary/essential-health-benefits/

[lumberjack_jeff]

37. Insurers are able to sell their old insurance.

But to be eligible for sale on the exchange, those plans have to comply with the gold/silver/bronze actuarial values (80%,70% and 60% IIRC)

a) It was a business decision to discontinue the plan the poster had previously.
b) The fact that ACA removes sex as a rating criteria is responsible for 15% of the premium hike.
c) The poster didn't mention what, if any, premium subsidy he is eligible for.

[randome]

59. Did anyone truly think Obama meant he personally controlled all private insurance companies?

When someone says something like that, it's usually not taken at literal value. No one can force a private insurance company to not change plans.
[hr][font color="blue"][center]Treat your body like a machine. Your mind like a castle.[/center][/font][hr]

[dkf]

60. Frankly it was deceptive marketing.

[ReverendDeuce]

3. Already looked...

I looked at our state's "price chart" that came out a week ago, and every single one of the plans look bloody awful, through all of the providers.

There is no way for me to get a 0% copay without going to a high-deductible ($6500+) plan...

I don't plan on getting sick, but I did have a broken limb two years ago that cost, in total, nearly $80K. A 50% copay would have had me in the hole for $40K! So what happened to all the talk about keeping people from going bankrupt due to medical bills? These new ACA plans look tailor made to send people people straight into financial oblivion...

[Ms. Toad]

16. Not correct.

Out of pocket expenditures are capped, so your broken limb would have cost you no more than out of pocket max for the plan with the worst benefits (which is around $6,000 for 2013 - the other plans have lower out of pocket maximums). When you pay a 50% co-pay, you only pay it until you have spent the maximum you can be required to spend for the year. Using $6,000 for simplicity (I think it is actually $6250), and assuming any deductible is already met, you would pay $6,000 for the first $12,000 of the bill, and the insurance company would pay the remaining $68,000.

The reason you have a 0% copay at a high-deductible ($6500) is because once you spend $6,500 you have already spent the maximum any ACA compliant plan can require you to pay - so the plan would pick up 100% of all covered costs after that.

[ReverendDeuce]

19. Ahh, okay... so...

My current copay is 0%, and my deductible is $1,500, and max out of pocket is $1,500.

I have this plan and I like it. Why am I being forced to change it?

[djean111]

26. Because your employer and BC/BS want to change it.

Most workplaces offer changes each year. Some stick with what they are offering, some change insurers, some change plans.
Rest assured that many increases will be blamed on the ACA, when that is not the truth.
This is one of the problems with having health insurance through the employer - the employer gets to decide each year, really.

[subterranean]

30. He said it's an individual plan, not an employer-sponsored plan.

[djean111]

39. Ah, my mistake.

I do think there will be a LOT of increased premiums, private or employer-based, that are blamed on the ACA, though.
Any health insurance I have had has gone up every year.

[Ms. Toad]

33. The plan probably didn't include all the no-charge benefits

ACA compatible plans are required to incude (no lifetime max, no-charge preventative care, just to name two), and BC/BS may just not be offering its age/health based plans now that the marketplace plans are starting. (I don't recall whether they were permitted to continue offering them or not - but if they are participating in the market place and are permitted to keep the old plans they would be insane to actually do so, since all the young healthy people would continue their low cost plans - and all the older/people with pre-existing condition people would flock to the exchange plans).

But insurance companies change plan structures all the time - there are never any guarantees (completely unrelated to the ACA). Our previous insurer dropped the plan we had a couple of years ago, and didn't even offer any with equivalent benefits at any price (after increasing the premium 20+ percent a year for years).

[Travis_0004]

35. At least for me, the state insurance exchanges don't look to be cheaper

Also, buying from the exchange, vs your employer has a lot of downside, and some extra taxes, since health insurance premiums on the exchange are bought with after tax money.

1. Health expenses can only be deducted to the extent to which it exceeds 7.5% of your adjusted gross income. If you make 30000 dollars, the first 2250 you pay for insurance can not be deducted. This is not an issue buying from your employer with pre tax money, as 100% was deducted.

You still bay OASDI taxes (social security and medicare) on all gross income. So even if you deduct insurance payments, you still are paying extra taxes.

Most states don't tax health insurance paid with pre-tax money. So your state income tax may go up.

Even if you get a large deduction you have to wait until January to file for it. Obviously you could change your W-4 to have your employer withhold less, but a lot of people won't think of this or know how to do it. Lets hope Human resources managers are paying attention, but even then a lot of them don't have a thorough understanding of the US tax code.

Even if the exchanges offered cheaper rates than an employer, it might still cost the employee more to buy from the changes, after calculating all the tax penalties.

This won't affect 1099 employee as much, since they can claim the cost of insurance as a business expense, but they would still be hit paying OASDI/Self employment taxes.

This may be a moot point for a lot of people who didn't have insurance before, but I'm afraid there may be some people who see that the exchanges are 50 bucks cheaper a month, then switch, and can't find out why they no have less money in their pocket (and maybe have to wait a year for open enrollment to switch back)

[gulliver]

6. Take the story to a journalist. It means nothing here.

The problem is that any Joe Bozo can post any crap they want to on DU. This type of "my personal experience" OP, positive or negative doesn't mean anything. Your story could be pure bull, and we have no way to know. There are probably loads of reporters who would drool over an authentic story with the parameters of the one you are telling. I haven't seen any reports like this, but maybe yours could be the first. Get a non-anonymous reporter to check your story and put it in a real media outlet.

[ConservativeDemocrat]

28. Why do you have to immediately assume he's not telling the truth?

If there are 99% winners and 1% losers from the ACA, it still makes it a good law. But you instantly assume that he must be lying because he's not getting as good a deal.

My personal take is that what's happening is that his employer decided to scrimp on the health insurance. The leat we can do is to be helpful.

- C.D. Proud Member of the Reality Based Community

[gulliver]

29. I don't.

You are assuming I am assuming that. I don't know whether he is lying or not, so his post can't be taken as meaningful. There is no way to really establish trust other than to bring in a trusted third party. That is what I suggested he do. Sorry, but that's just common sense. I wouldn't believe he caught a 30 lb. bluegill either, no matter how sincere he seems.

[Mellow Drama]

7. Small price to pay for everyone to be covered no matter how poor they are

We really should be thankful we can afford what we can, and do whatever it takes so that we get the rich to fully fund health care so we don't have to put up with the burden. I'm willing to pay a little more, but this give us leverage at our university to denounce the republicans

[Fumesucker]

8. I'm sure you'll be happy to help the OP with their new financial obligation

Seeing as how it's a small price and all.

[woo me with science]

9. The influx continues.

It's just an amazing phenomenon, the constant influx of posters spouting the corporate line, and the steady, wholly unnatural increase in the ratio of corporate to traditional Democratic posters.

It's just magical.

[Mellow Drama]

11. I know, right!

My professor says it's because of entrenched republicans who are trying to sabotage the ACA, in doing so they have created an opportunity for the private health care firms to screw us even more. But as long as we stay focused, we will win!

[Fumesucker]

12. "Any sufficiently developed magic is indistinguishable from technology" -Agatha Heterodyne

[woo me with science]

14. ...

...



This Luddite is MYSTIFIED.

[Puzzledtraveller]

56. If the exact same law was passed by a Repub they would be the most vocal opponents.

This is just party worship, at all costs.

[Yo_Mama]

45. Especially that 50% copay

The bottom line is that many people with moderate incomes aren't going to be able to get healthcare. They'll have insurance, but unless they have hundreds or thousands in the bank, they won't be able to get treated if they get sick/injured.

[CrispyQ]

53. Yes. Health care vs health insurance, they are not the same.

So the ACA is really the AIA, except that it's not.

[LanternWaste]

58. Which is precisely what is being done all doing via the mechanism of coverage for all.

Which is precisely what is being done all doing via the mechanism of coverage for all rather than a much- less-than-effective (though quite imaginative) solution of mailing someone a twenty dollar bill...

[winter is coming]

52. No, everyone will not have insurance under the ACA.

It's an improvement over the current state of affairs, but there will be poor people who don't qualify either for Medicaid or a subsidy. They're supposed to get an exemption from the mandate.

As for the OP, sounds like they're jacking the cost of insurance to get him off the "company" plan. I wouldn't be surprised if we see a lot of that. It's a way to decrease the number of employees a company pays insurance for without overtly denying coverage, which would entail a penalty. I'm hoping this sort of tactic will lead to single-payer.

[Hannahcares]

10. Cost of individual policy

I carried a Bluecross individual policy for 10 years until I moved to another state.my monthly premium for the past 3 years was $ 1359 ( just for me, DH paid another $820 for his policy) deductible was $1000 and 20% co/pay until reaching max. Out of pocket of 8,000. How in the world did you get such low rates on BCBS individual policy? I've never heard of such a low cost policy?

[ReverendDeuce]

21. BCBS Nebraska is my insurance company...

I have the HSA 1500 plan and have for four years.

I bought it from nebraskablue.com. It was their advertised rate for a male non-smoker aged 31 at the time. It has gone up about 5-10% per year to where it is now.

It's not a sketchy policy, either. When I had my broken leg two years ago, no questions were ever asked. Everything was approved, including all my physical therapy and mobility hardware. I paid a total of $1,500 exactly, no more.

[dsc]

34. I looked and they appear to be still selling the policy

I didn't get a quote since I don't live there but here is the link where I found what I think is your plan described.

https://www.nebraskablue.com/shop-plans/individual-and-family/high-deductible/blueessentials-hdhp-sbcs/

[nadinbrzezinski]

13. It is the insurance company

We got letters from both Tricare and VA.

Blue cross is (like good private sector) is trying to screw you. If you are in a state with a friendly congress member and senators also contact your delegation and the state administrator for the system

[brentspeak]

15. How/when did you come by that gold-plated individual Blue Cross plan?

A 0% copay??? For only $153/month -- and a low deductible?

[Ms. Toad]

17. Some short term policies

which do not cover pre-existing conditions, are around that (based on age). They also often have very low caps on annual and/or lifetime benefits.

[ReverendDeuce]

18. Wrong...

My plan was the Blue Cross HSA 1500 plan, it was not a short term plan. I've had this policy for four years now.

[JaneyVee]

20. Did you have a major health problem recently?

Your plan seemed incredibly low for such a good plan.

[ReverendDeuce]

22. Two years ago a broken leg...

Spiral fracture, rods and screws and the works. Around $80,000 in total bills. Of that, I paid only $1,500 (my deductible).

[JaneyVee]

24. Hmm, that doesn't sound too major. But I wouldn't put it passed the

Insurance company to use that to justify a rate jump.

[ReverendDeuce]

47. This was two years ago and my rates did not go up last year any more than usual.

The language in the packet clearly states that the policy I have is going away because it is incompatible with ACA.

[ReverendDeuce]

23. I know, I don't understand it... maybe it's because it's Nebraska?

I can photocop/scan the plan details, but I bought it on-line. I just plugged in my age, gender, zip code, and it presented me a menu of options.

I realize I don't have mental health on the plan I currently have, so that is an added benefit from ACA, but still -- $80+ a month increase? Ridiculous.

[Red Mountain]

25. Nothing like that available in NC

Not even close. $80 more? We'd be happy with that.

By all means.......provide the details.

[Ms. Toad]

32. Then I suspect you are young, likely male, and in perfect health -

The rate you quote would be fairly typical for a male up to mid-20s, without any pre-existing conditions.

(As to the details - that plan varies from state to state, so it is hard to tell what is included or not.)

[phleshdef]

38. So it was an HSA?

I don't consider an HSA to be a real insurance policy personally.

[Nye Bevan]

43. An HSA is not an "insurance policy". You take out an HSA *together* with an insurance policy.

Say your annual deductible is $1200 and you are in pretty good health. You can put $100 per month into your HSA, and deduct it on your taxes, and then if you have any medical expenses you can use the money in your HSA for your deductible. If you are lucky enough to have less than $1200 in medical expenses you can keep the money and roll it over into the following year. You can also use this money for dental, eyeglasses, and so on.

[ReverendDeuce]

50. This is merely semantics... an insurance policy with an HSA is still an insurance policy.

So my plan has an HSA attached, it doesn't mean it's not a real insurance policy... LOL.

How else would I have dodged the price tag of my broken leg two years ago?

[subterranean]

31. Just curious, what did they change to make it "ACA compatible"?

All of the benefits you mentioned exceed the requirements of the ACA.

I'm not an insurance expert, but from what I've read, insurance companies can't just switch you from one individual plan into another with different benefits at their discretion. I thought the only thing they could change is the premiums. They can discontinue a plan, of course, but then you should be able to choose which one you will enroll in next.

[ReverendDeuce]

40. What is different...

That's what they are doing, they are discontinuing this plan and automatically enrolling me in one they feel is the closest match, which is far, far from being the closest match. Indeed, none of their policies are a close match in cost or coverage.

They shattered my low-deductible and 0% copay.

They added maternity, pediatric dental/vision, and mental health/substance abuse.

[Nye Bevan]

48. Bear in mind that under Obamacare you will get preventive care totally free,

with no copay, regardless of whether you have met your deductible.

So you will get an annual checkup completely free as well as the following services:

Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked
Alcohol Misuse screening and counseling
Aspirin use for men and women of certain ages
Blood Pressure screening for all adults
Cholesterol screening for adults of certain ages or at higher risk
Colorectal Cancer screening for adults over 50
Depression screening for adults
Type 2 Diabetes screening for adults with high blood pressure
Diet counseling for adults at higher risk for chronic disease
HIV screening for all adults at higher risk
Immunization vaccines for adults--doses, recommended ages, and recommended populations vary:
Hepatitis A
Hepatitis B
Herpes Zoster
Human Papillomavirus
Influenza (Flu Shot)
Measles, Mumps, Rubella
Meningococcal
Pneumococcal
Tetanus, Diphtheria, Pertussis
Varicella
Learn more about immunizations and see the latest vaccine schedules.
Obesity screening and counseling for all adults
Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk
Tobacco Use screening for all adults and cessation interventions for tobacco users
Syphilis screening for all adults at higher risk

And women get the following totally free:

Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked
Alcohol Misuse screening and counseling
Aspirin use for men and women of certain ages
Blood Pressure screening for all adults
Cholesterol screening for adults of certain ages or at higher risk
Colorectal Cancer screening for adults over 50
Depression screening for adults
Type 2 Diabetes screening for adults with high blood pressure
Diet counseling for adults at higher risk for chronic disease
HIV screening for all adults at higher risk
Immunization vaccines for adults--doses, recommended ages, and recommended populations vary:
Hepatitis A
Hepatitis B
Herpes Zoster
Human Papillomavirus
Influenza (Flu Shot)
Measles, Mumps, Rubella
Meningococcal
Pneumococcal
Tetanus, Diphtheria, Pertussis
Varicella
Learn more about immunizations and see the latest vaccine schedules.
Obesity screening and counseling for all adults
Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk
Tobacco Use screening for all adults and cessation interventions for tobacco users
Syphilis screening for all adults at higher risk

See http://www.hhs.gov/healthcare/facts/factsheets/2010/07/preventive-services-list.html

[Nye Bevan]

42. Have you checked to see whether you are eligible for a subsidy based upon your income?

(If you are single, that would mean an income below about $45,000).

This could significantly cut the cost of your premium.

See http://kff.org/interactive/subsidy-calculator/

[ReverendDeuce]

46. Not eligible for any subsidy. n/t

Unfortunately.

[IronLionZion]

44. I would expect most insurance companies would jack up the prices

due to uncertainty over what would happen. Especially if they expect a lot of newly insured folks seeking treatments for major stuff they didn't have access to before. So they would jack up prices to try to hedge their risks. Then lower it in a year or so because of competition. Aetna and other big players have pulled out of some of the exchanges for this reason, but I expect they will be back in a year or 2 with competitive pricing.

Shop around for other plans. There is a functional and regulated individual market now so there may be better plans for you out there.

[tridim]

51. BCBS in Missouri just keeps sending me rebate checks.

My premiums have fallen over 50% because of the 80/20 part of the law.

Sounds like your local BCBS office is run by an ODS Republican. I would shop around for a better deal offered by a company who follows the law.

[ReverendDeuce]

54. Nobody selling insurance in this state has anything remotely close to what I already have...

BCBS NE already followed the 80/20 rule, so no rebates. Got a letter about that some time ago.

All the other insurance companies in the exchange are around the same rates.

Miserable plans with a drastically higher premium.

[Puzzledtraveller]

57. Because you buy your own insurance

My employer, The Commonwealth of Kentucky pockets mine and then doesn't apply a discount. My premiums are raising this year I will have no choice but to go with the bare bones plan.

[Puzzledtraveller]

55. We are at the 26th Dimension

Just wait, the supreme gambit is sure to come, and stop being critical anyway. Our side won, that's all that matters.