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The New Health Care Law, Health Ins & 'New Plans'
Old 06-21-2010, 01:04 PM   #1
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The New Health Care Law, Health Ins & 'New Plans'

I don't know if this is old news but it was not such to me.
I got a health ins. rate increase because I turned 55. While researching other plans with BCBS I was read a disclaimer similar to the info below.

The important part is this. If I change plans (now a new plan) the government can mandate what needs to be covered and the health ins can (will) raise the premium. So if the government says my (new) plan must include and pay for 100% of an annual physical to include X,Y,Z tests, the plan would have to include it and I would have to pay for it.

If I stay with my current plan no such clause applies. But, I usually try to change plans or ask for a 'rollback' to save money. For example I can change from a PPO to a POS plan and save $45/month - similar in the important issues - dr. selection and money.

I move to medicare in a 7? years. So I will continue to change plans until then.

I'm guessing people will be moving to the government plan over time.

https://www.bcbsal.org/HCReform/inde...m=grphomeHcRef
The Act requires modifications to new and grandfathered health plans to comply with the mandates set forth in Title I (Subtitles A and C) of the Act. A grandfathered plan is a group or individual plan in which an individual was enrolled on or before March 23, 2010. If a group develops a new plan after March 23, 2010, or an individual enrolls in an individual plan after March 23, 2010, that plan is then considered a new plan. A grandfathered plan must comply with some of the mandates of Title 1 while a new plan must comply with all of the insurance mandates in Title I. Please refer to the "Grandfathered Plans" below for application of each mandate in Title I.
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Old 06-21-2010, 02:44 PM   #2
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a POS plan
That's the kind I have.
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Old 06-21-2010, 02:57 PM   #3
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That's the kind I have.
Me too. But, at least it's my chosen plan.
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Old 06-21-2010, 04:06 PM   #4
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Yup, it will become progressively harder and harder to find (cheaper) plans that offer no preventatives as an option, since those will be mandated for new plans.
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Old 06-21-2010, 08:49 PM   #5
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FYI my costs increased 25% because I am now in the 55-60 age group.
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Old 06-24-2010, 08:12 AM   #6
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Dex, how do you move to Medicare in 7 years at age 55 now? You mean 10 years right?
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Old 06-24-2010, 09:33 AM   #7
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Dex, how do you move to Medicare in 7 years at age 55 now? You mean 10 years right?
Is it 65 you can start? I haven't researched it yet. I have projected my current medical ins. until death. I will be taking SS at 62.
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Old 06-27-2010, 12:48 AM   #8
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Yup, it will become progressively harder and harder to find (cheaper) plans that offer no preventatives as an option, since those will be mandated for new plans.
You won't be able to find any plans at all with no preventative care starting in September...
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Old 06-27-2010, 01:36 PM   #9
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You won't be able to find any plans at all with no preventative care starting in September...
I sticking with the 'old' plan until the end of the year. Then I will be able to evaluate the cost of the 'old' plan (and new cost) against other plans.
I have been able to keep ins. costs around $200/mo - with similar benefits - for 4 years, by changing plans and asking for rollbacks. I'm guessing that will be more difficult in the future.
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Old 06-27-2010, 02:06 PM   #10
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I sticking with the 'old' plan until the end of the year. Then I will be able to evaluate the cost of the 'old' plan (and new cost) against other plans.
I have been able to keep ins. costs around $200/mo - with similar benefits - for 4 years, by changing plans and asking for rollbacks. I'm guessing that will be more difficult in the future.
Would you be willing to share the name of your company? And be more specific about your plan: i.e., deductibles, any exclusions, etc. That would be helpful for those of us with really big premiums. Mine with Great West Insurance is $431/mo with a $2700 deductible, and covers no preventative dr. visits or tests. Also, I have an exclusion, which luckily at this point doesn't require any treatment. Such a deal!
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Old 06-27-2010, 02:30 PM   #11
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Would you be willing to share the name of your company? And be more specific about your plan: i.e., deductibles, any exclusions, etc. That would be helpful for those of us with really big premiums. Mine with Great West Insurance is $431/mo with a $2700 deductible, and covers no preventative dr. visits or tests. Also, I have an exclusion, which luckily at this point doesn't require any treatment. Such a deal!
BCBS of Georgia - you can go to their site and see the plan options.

I just got an increase from 160/mo to 202/mo for turning 55 (55-60 age group)
Smartsense 5,000
3 dr visits w/tests for $35 copay
5,000 deductible 70/30 split - I think
8,000 max out of pocket
generic medicines
Emergency room 70/30 split

Again you can save $ by switching plans - there is a similar plan to the above that has a different Emergency room plan and doctors included. Let's say the above plan has 98% of all doctors the other plan has 95% - the other plan has my Dr. ans Hospital so no issue. It was about $160/mo
Note
Asking for a Rollback is asking for a review of your plan and it dies not cover existing conditions - for 18 months, I think. I don't have any.
Also, going to a new plan - existing conditions may not be covered.
Obamma care might have changed that. Maybe that is why I couldn't get a rollback when I asked about it.

The deductible depends upon your condition and medical history - what is likely to happen.

Let's say you raise your deductible to $5,000 and generic medicine - est. save 200/month or 2400/yr it would take about 1 year to cover the increase from 2,700 to 5,000 if you needed it or 2 years to cover the total 5K

Another way of thinking about the deductible is that if you are using $5K something serious happened and you will need time to recuperate. So, you will not be using other money in your budget - eating out or traveling.

Let me know if you have any other questions.
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Old 06-27-2010, 10:46 PM   #12
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BCBS of Georgia - you can go to their site and see the plan options.

I just got an increase from 160/mo to 202/mo for turning 55 (55-60 age group)
Smartsense 5,000
3 dr visits w/tests for $35 copay
5,000 deductible 70/30 split - I think
8,000 max out of pocket
generic medicines
Emergency room 70/30 split
Taking a plan that doesn't cover brand name prescriptions is like taking a plan that won't cover hospital bills over $5k. I would very very strongly recommend you look into what it would for a similar plan that has full coverage for brand name drugs. Here is a post from the insurance forum I post at from a member there, might make you think twice. Keep in mind that Tarceva is not even among the most expensive cancer drugs:

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Hi guys. It's been several years since I left the insurance biz, but I was hoping I could get some advice from you in this troubled time for my family as this forum was always great to me as I tried to build up my business.

My aunt was just diagnosed with lung cancer called EGFR mutation and has been prescribed 150mg of Tarceva, which should treat this to some degree. The really bad news is that she didn't choose any type of Rx coverage on her individual plan. The condition is terminal but she could live for several years. However, the cost of the Rx is $5,000+ per month out of pocket which would wipe her out financially.

She lives in DC and has a Personal Comp Plan through Care First Blue Cross Blue Shield.
Annual deductible of $500
Annual family aggregate deductible of $1,000 and
Out of pocket cost limit of $2,000
All policy benefits are paid at 80%
No Rx coverage
They will reimburse for Rx for $500 after deductible on an annual basis. She has an ARGUS prescription discount program that is associated with this policy, but I am not familiar with this and guess it is worthless.

She also has a Catastrophic Individual Policy with Care First Blue Shield.

Is there is anything that she can do to get this Rx covered or is she going to have to pay for it all?

Thanks in advance for any help.
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Old 06-28-2010, 12:10 AM   #13
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Taking a plan that doesn't cover brand name prescriptions is like taking a plan that won't cover hospital bills over $5k.
Yes, very risky. Many treatments have no generic equivalents.
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Old 06-28-2010, 07:09 AM   #14
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Taking a plan that doesn't cover brand name prescriptions is like taking a plan that won't cover hospital bills over $5k. I would very very strongly recommend you look into what it would for a similar plan that has full coverage for brand name drugs. Here is a post from the insurance forum I post at from a member there, might make you think twice. Keep in mind that Tarceva is not even among the most expensive cancer drugs:
Here is how BCBS handles it.
BlueCross BlueShield of Georgia

Plan Details – SmartSense POS – Blue Cross Blue Shield of Georgia Health Insurance
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Old 06-28-2010, 07:36 AM   #15
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That plan does cover brand name drugs, though it is restricted to only the BCBS formulary. The BCBS SmartSense plans work a little differently here in Virginia...they're PPO plans instead of POS, but they also give you the choice of having the prescriptions restricted to the BCBS formulary like your plan or the option to include coverage for drugs not on the formulary too for about an extra 2% in monthly premium. I always recommend paying the extra premium since you never know when the drug you need might not be on the formulary, but at least you have coverage for some brand names.
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