Health reform plans, pricing released in Calif.

[Zorro]

Source: AP

Californians are finally getting to see what "Obamacare" means for them.

President Barack Obama's health care overhaul made a big leap Thursday when California's health insurance exchange announced the plans and the prices that will be offered to those buying individual coverage.

Some of the state's largest individual health insurers, including Anthem Blue Cross, Blue Shield, Kaiser Permanente and Health Net Inc., will be among 13 plans competing through the state's new health exchange.

The rollout in the nation's most populous and diverse state is important because it demonstrates how the Affordable Care Act will work on a large scale, health policy experts said.

Read more: http://news.yahoo.com/health-reform-plans-pricing-released-232824183.html

---

This is a big deal. The premiums look reasonable.

Aetna, CIGNA, and UnitedHealth reportedly are not opting in to the California exchange.

[dixiegrrrrl]

1. Have you ever known insurance premiums to go down?

Once they get people locked in, the premiums will rise and rise, esp. if the state insurance board is captive to the insurers.

[Zorro]

3. Yes. I've seen insurance premiums go down.

There's a range of premium payments per insurer listed. It may actually lead to some competitive rates in the future.

[State the Obvious]

4. I thought that if premiums are raised to an extreme...

(and out of the competitive price range), the insurance company would be removed from the exchange. Anyone else hear this?

[duhneece]

2. The three biggest health inusrance companies AREN'T opting in?

What does that mean? I know these 3 are huge, but I don't know for a fact that they are the 3 largest.

[PoliticAverse]

5. This LA Times article gives more background on the opt outers...

http://www.latimes.com/business/la-fi-health-insure-20130523,0,1895918.story

[duhneece]

20. Good info-thanks nt

[Zorro]

6. It means they're assholes

I've had both Aetna and CIGNA coverage in the past, and dealing with them was an exercise in frustration.

[freshwest]

10. Dealt with both. They did me and mine serious damage. If I was in CA, I wouldn't pick 'em.

[Thinkingabout]

7. In comparsion to seniors Medicare cost of $104 a month these rates are good.

SS pays on average of $1400 a month so if I did not have insurance these rates would be good for me. I am looking forward to see what the rates will be on the national exchange for states like Texas who opted out of the plan. I am hoping it will be a good deal.

[madville]

8. Was checking out the rates

Average was $321 a month for a Silver plan (70/30) plan. They are not releasing family rates until the fall from what I read, I would expect those to be around $800-1000 a month. They have a table that shows what the subsidy will be based on income and the poverty line, it could be anywhere from 100% to 0% subsidized, like if you made $30k a year the premium would only actually be $160 instead of $320, etc.

[madville]

9. It also increased with age of course

a 21 year old might have a premium $300 while a 40 year old might be $400 a month.

[Pachamama]

11. Do you know a link where I can see these premiums? Very curious to see the options & pricing n/t

[State the Obvious]

12. Try this link....

Under "Latest News"....

http://coveredca.com

[madville]

14. coveredca.com

coveredca.com

[Nay]

16. A family rate of $800-1000 a month? What a fucking joke. Unaffordable by most people!

[flamingdem]

18. If it's that high their income would indicate they can afford it

otherwise they will get a supplement.

Don't judge until you run the numbers.

[bread_and_roses]

22. No, a $35,00 yr single mother of three CAN'T AFFORD $114.00 month

And that's WITH subsidies. Here's one of the examples on the page:

A single mother of three kids earning $35,000 per year

If you are a 40-year old single mother of three earning $35,000 per year, your costs for health insurance might be as much as $48,784 per year if you were to pay the entire premium. However, if eligible, you will qualify for about $7,416 in tax credits to help pay your health insurance premiums. After applying the tax credit, you would be responsible for $1,368 annually – about $114 each month – for premium payments for the sliding scale plan for your family size and income level. You could also choose to apply your tax credit to a more, or less, expensive plan.

No, $114.00 a month is NOT "affordable" for "single mother of three earning $35,000 per year."

This is insane.

Oh, and what kind of monstrous twisted mind thinks it's OK for people to have "platinum" or "gold" or "silver" plans? People DON'T KNOW what kind of health care they are going to need tomorrow.

[sinkingfeeling]

23. How much would she pay to take a kid to the ER?

[bread_and_roses]

38. I don't think you get it

If you are working with that kind of income with three children to support, you pay what you absolutely have to when you absolutely have to - and that's about it.

You do not have $114.00 to spend on health care in the month's one of the kids is not sick. Take a look at the MIT Living Wage calculator for California.

http://livingwage.mit.edu/states/06

For an adult with three children
Food - $749
Child care - $983
Housing - $1,806

$35,000yr is a bit under $3000 mo. The above = over $3,500. See more - including other expenses I left out - at the link.

The calculator estimates $429 a month for medical. Which of course is considerably more than $114. But that's an annual estimate divided by 12 - and the point is that on that budget you are not going to spend anything on medical in a month you don't have to - and when you do, something else is not going to get paid.

And I can almost guarantee you that the food $ are too low in actuality. That's less than $200 wk for four people - not easy. The USDA "Thrifty" food plan calculates 634.20 for a family of four - and believe me, you don't want to be limited to eating what's on the "thrifty" plan (it's not an exact comparison - the plan estimates for 2 adults, 2 children/2 different age groups, of which I took the (slightly) higher figure).

I am not speaking without any knowledge of the issue. I worked on living wage as an issue for years, and also worked professionally with families at this income level and below. I have seen a woman with this range of income and family size break down in tears when a child accidentally ruined a pair of shoes and she had to buy a new pair. And she was NOT a "bad money manager" - far from it.

This "reform" is a farce and a monstrosity that was crafted to benefit the Vampire Insurance companies, not the health care needs of the people.

[madville]

28. Don't forget the co-pay either

A silver plan would be a 70/30, meaning the health plan pays 70% of the bill and the insured pays 30%, up to around a $12,000 annual cap. The premium is the easy part.

[antigop]

13. The max out of pocket is still too high for a lot of people

The maximum out-of-pocket cost per year for most plans will be $6,350 for an individual and $12,700 for a family.

[madville]

15. I'm waiting to see what the family plan rates will be

Judging by the individual rates family coverage will probably have premiums around $800-1200 a month, a subsidy could knock that down somewhat but even if it was $300 a month after the subsidy it would still not be affordable for many. Especially with the bronze 60/40 and silver 70/30 models, the user still has to pay 30% of the bill as well up to the max out-of-pocket limit you mentioned.

[flamingdem]

19. What about the subsidies?

I'm guessing, but don't know yet, that only high earners will pay that amount. Many high earners get insurance through work with less out of pocket.

[Nay]

25. When you consider what the govt considers as the poverty level, it's not a stretch to

think that the govt will consider a family of three making $40,000 as 'high earner.' They'll get high premiums AND a 70/30 or 60/40 plan that, if they have a half-serious medical issue, will break them in one year. Imagine a car accident where your toddler needs surgery and physical therapy. Total cost ends up about $75,000. You pay 30 or 40% of that. Shudder.

[antigop]

26. or you have a chronic condition that requires treatment each year

Imagine paying the max out-of-pocket year after year after year.

Or a family of four has multiple members with chronic health problems.

[BenzoDia]

17. Thanks for posting this.

[sobenji]

21. Really people?

Do you people bitching about the costs of the premium have ANY CLUE what premiums are right now for individual insurance?
If you have had an individual policy for more than 3 years, these rates are extremely competitive. Not to mention no medical underwriting. That's what you are missing here. If you have an individual policy and you get sick (and trust me, there are a crapload of diagnoses that get you deemed "sick&quot , you have no choice. You can't shop around because suddenly you're uninsurable.
This fixes that.
These rates are GREAT news. Add in the subsidys for up to 400% of FPL (single making less than 44k, fam of 4 less than 92k) and affordable health insurance that will keep most people from being bankrupted by a serious illness is here and available to all.

It not single payer, or even a public option but this is fantastic news.

[Le Taz Hot]

24. Yes, really, people!

Yes, we DO know what the cost of premiums are right now and we can't afford them either. You've obviously never lived on a TIGHT budget, and I'm talking TIGHT -- as in your budget for your food bill for 2 people is $150.00 a month -- IF it's a particularly profitable month. Yes, there will be MANY people who can't afford these "discount" rates, especially with some plan in which you're responsible for 30% of the bill.

Go excoriate someone else and leave the poor alone.

[sobenji]

27. If you are that poor

You would be eligible for Medicaid.
And if that's the case, why even comment?

And yes, I've been there.

[Le Taz Hot]

30. 1) I never personalized it,

2) not necessarily because there's a WHOLE lot of holes in social programs and
3) because it's a message board and the last I checked we still had a First Amendment.

Enjoy your stay at DU.

[sobenji]

39. Wasn't trying to

I was just commenting on the $150/month food budget.

[KatyMan]

32. Medicaid coverage varies by state

in Texas- poor adults are not covered unless they are disabled. End of story.
Children are covered under CHIPS.

But working adults at minimum wage at jobs with no insurance are screwed. They do not qualify for anything.
Unemployed is the same story.

I am always amazed at what people think Medicaid is and is not.

[Sgent]

52. The ACA

expanded Medicaid coverage to require it for all people (disabled or not), this requirement, unfortunately, was overturned by SCOTUS.

[flamingdem]

35. You are right. If you can't afford it there is Medicaid

and the majority in CA will be enrolled into that.

[Nay]

45. Non-disabled adults in VA do not ever get Medicaid; kids can be covered under a state program.

That's it.

[flamingdem]

46. This is brand new in CA

A shame they don't have it in VA. What a relief to so many adults who are unemployed now etc.

[Politicalboi]

47. I live in Ca and I'm not 65, I'm 52

Nor do I have children. I am NOT eligible for medicaid. I am screwed. I take care of my 86 year old mother, and am not working at this time. Even $100.00 a month is too much for me to pay. I have needed to see a doctor for years, but can't go with no insurance. Unless they are going to make a change in medicaid, I won't be insured for years, unless my mother dies, and I go back to work.

[Melinda]

48. You should be able to receive MISP services in LA.... info within:

And I say this just based on the limited info in your post. I don't mean to presume, but just in case you aren't familiar, here are the details. From their website (note to mods, this is a government website with no copyright limitations; all info pasted herein shouldn't have to meet 4 paragraph rule):

From: http://www.ladhs.org/wps/portal/HWLA

With Healthy Way L.A., you choose a permanent medical home at one of more than 100 clinic sites. With a medical home, you go to the same location for nearly all of your medical care needs. Your medical home is staffed by providers who know you by name and how to keep you in optimal health.

Take the first step to good health by seeing if you can enroll. You must meet the following eligibility requirements to enroll in Healthy Way L.A.:

Residency: Los Angeles County
Age: Adult, 19 to 64 years of age
Citizenship: U.S. Citizen/National or Legal Permanent Resident of 5 + years
Income: Monthly income limit ($1,239 or less for a family of one)
Pregnancy: Not pregnant or eligible for Medi-Cal or Healthy Families

Healthy Way LA (HWLA) is a FREE health program. We will never charge you to complete your HWLA application. HWLA or HWLA pending patients should not receive a bill from DHS for health care services. If you are a HWLA or HWLA pending member and you receive a bill, please contact HWLA member services. Only Department of Health Services employees and contracted partners can process your HWLA application. Please call 1-877-333-4952 if you have questions about the HWLA program.

If you meet the requirements above, Healthy Way L.A. could be your passport to a healthier life. Healthy Way L.A. covers both outpatient AND inpatient services. Plus, you receive many other benefits like:

Primary Care by Appointment
Access to in-house pharmacies to fill your prescriptions
Assigned “Medical Home” at a location near your home or work
Preventive Care & Mental Health Services
Access to Specialists
Care Management Services for chronic illnesses like CHF & Diabetes
Urgent & Emergency Medical Care Coverage
24/7 Nurse Advice Line
Translation Services
Caring, Multi-cultural staff who understand your needs

If you meet the eligibility requirements above, enroll today to start enjoying the peace of mind of having health care coverage. If you are currently going to a DHS or a Community Partner clinic , you can enroll at that location. Due to the high volume, enrollment capacity is currently limited and is on a first come, first serve basis. We are working to expand our enrollment capacity to expand HWLA coverage to all who are in need.

If you have questions, our trained specialists can help you. Call 1- 877-333-HWLA today.

To find a clinic near you, please check the HWLA Provider Directory for a complete list of HWLA medical homes. To see if a clinic is open to new patients, please check our Open/Closed list and make sure to call ahead of time.

-------------------------------

Almost every low income resident of CA who is not eligible for Medi-Cal is eligible for what are known as either 1) County Medical Services Program (CMSP) OR 2) Medically Indigent Service Programs (MISP). The first is found in 35 of CA's 58 Counties, the second in the remaining counties. LA falls into the 2nd category, and the info I pasted up top is for LA County. There is no reason you should not be receiving medical care unless LA has a hold on its program - Counties experiencing financial difficulties have been known to suspend these programs very briefly. I hope this helps.










http://www.ladhs.org/wps/portal/HWLA

[KatyMan]

31. it is not just the poor

Those who have insurance through their employer are often paying over 300.00 per month to cover a family. I am. I also have a 4500 single deductible; 9000 for the family. Out of pocket maximum is 12,000 for family. This is through my wife's employer- and she works for one of the largest insurers. It was even worse when she worked for United Health.

[Le Taz Hot]

34. See? That's the other side of this.

I think I read that most medical bankruptcies are from people who HAD insurance. The costs, and therefore, the copays, were so exorbitant that the money could never be paid back.

[flamingdem]

36. Do you know what you'll be paying starting 2014?

Do you qualify for subsidies?

[sobenji]

40. Co-ins, etc

Part of the ACA requires preventative health care with no deductible or co-pays, which should lead to healthier insureds.
Also, since the deductibles are high, when that need comes to seek treatment, wouldn't it be great if the ACA required hospitals to publicly post their prices?
[link:http://mobile.slate.com/blogs/moneybox/2013/05/08/price_masters_revealed_obama_forces_hospitals_to_publish_prices.html|
And the subsidies to purchase are tied to your income and will generally keep your premiums to not exceed 9.5% of income.
Add in a drug card, etc and there are legitimate reasons to celebrate this news.
I didn't mean to denigrate or slam anyone in general, just holy shit, this is a big fucking deal.

[sobenji]

41. Link for hospital prices

http://mobile.slate.com/blogs/moneybox/2013/05/08/price_masters_revealed_obama_forces_hospitals_to_publish_prices.html

[flamingdem]

43. Thanks for this. On a personal level I am

utterly relieved and helped by Obamacare. I am SO grateful Obama risked political capital on this. It humanizes our country and sets things up for further reductions in price and a healthier country. It helps the bottom percent of the 99% the most but many of the mid and uppers get okay insurance through work. I really think they have no idea what it means to pay as an individual.

[thearchive]

29. Better than the current system , MUCH WORSE than 10 years ago

$250 to go to the Emergency Room is unreasonable.

Out of pocket of $6,400 a year is crazy too. That's what I'd have considered catastrophic coverage 10 years ago.

Plus, these rates are for the "silver" program - which has a $45 copay to see your primary doctor.

This may be better than where we were headed without the ACA, but it's not very good compared to what we used to have - and what most other countries have today.

[KatyMan]

33. One of the goals

of insurers is to keep you out of the emergency room. You should be utilizing your primary care physician when possible. ERs are just that- for emergencies- not stomach/ear aches, etc.

And what do you mean- what we used to have? Last time I checked- there were always uncovered citizens.

This is better than anything the uninsured have ever had before (which was a big fat NOTHING)

[flamingdem]

37. This is right, it's a way to start bringing costs down

by getting the uninsured out of the emergency room. Obama has brought the deficit down, this is a way to move to a better system long run.

[sobenji]

42. No way

10 years ago if you were sick you couldn't buy insurance. big difference

[flamingdem]

44. Already in CA adults w/o children are getting coverage

First time ever that the poor or low income has this option. It's going to get millions on insurance and out of the emergency rooms. Fantastic really. Considering the resistance!

[Melinda]

49. Actually, low income folks in CA have had access to medical care for years thru either CMSP or MISP

Children, single parents, the disabled, and the elderly are eligible for Medi-cal (new and improved - it's now known as "CalViva&quot . Low or no income CA residents over 21 but under 64 not eligible for Medi-cal are eligible for either their own County Medical Services Program (CMSP) OR Medically Indigent Services Program; which program one receives depends on the county in which they reside. Low income folks in CA have had access to this service since the 1980's, although many CA residents aren't aware of it. It's the rest of America that's not as fortunate.

I think ObamaCare is gonna rock.

[flamingdem]

50. Are you sure single adults were eligible?

I thought this is the big change, not sure what qualifies one as indigent .. sounds like homeless. many single adults are unemployed or scraping by but not really indigent.. Just suffering the bad economy.

The biggest problem seems to be letting the populace know about these programs. So few even realize they can get coverage!

[Melinda]

51. I am positive - share the news!

Below is a link to eligibility requirements. Please note that 200% of Federal Poverty Level means that a single individual's annual income is less than $21,780.00 - which means an adult can have income (earned or non earned up to that amount) and be income eligible. The first $600.00 of each months income is exempted from the monthly budgeted need amount, which means that the lower the income, the less chance the individual may have a share of cost (co-pay) Basically it means that anyone earning less than $690.00 per month gets free CMSP or MISP, those over that amount pay a graduating share of cost (co-pay). So the very poor get free health coverage under these programs. So while CMSP and/or MISP are helpful to the poor, the ACA is going to lift those up who are low-income but still have a share of cost which can be hundreds of dollars each month. Lots of variables at play but here are the basic eligibility guidelines:

http://www.cmspcounties.org/pdf_files/forms/CMSPInfoNotice02-1005.pdf