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Old 09-05-2014, 05:38 PM   #101
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It's also a good time to look for the policy documents and call with questions. ...
And record your calls because they often are misinformed. Most states (80%) do not require you to disclose that you are recording the call Telephone recording laws - Wikipedia, the free encyclopedia
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Old 09-05-2014, 06:01 PM   #102
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I take it they do not define "elective surgery?" Does this mean they won't pay for a nose job, or they won't pay for, say, gall bladder removal?
That's the thing. Most policies exclude "elective cosmetic surgery". The Humana policy exclusion reads "Elective medical or surgical procedures". Last year I called and emailed looking for more precision, to no avail. The policy doc has been scrubbed, so the lack of clarity is no accident. Still, they have a large network and the price difference is pretty substantial.

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And record your calls because they often are misinformed. Most states (80%) do not require you to disclose that you are recording the call Telephone recording laws - Wikipedia, the free encyclopedia
Good point, but I wouldn't bet on that being enough to get the upper hand on an insurer.

One challenge we all face is the "contract" or certificate of coverage, is not available for inspection. An insurer like Kaiser P has an excellent reputation and might be given the benefit of the doubt. This is definitely not the case with the national insurers.
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Old 09-05-2014, 06:50 PM   #103
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And record your calls because they often are misinformed. Most states (80%) do not require you to disclose that you are recording the call Telephone recording laws - Wikipedia, the free encyclopedia
Good point, but I wouldn't bet on that being enough to get the upper hand on an insurer.
If you go through the trouble to get clarification of something that's not found anywhere in writing, and you use that information from the telephone call to make a buying decision, it sure would be nice not to have to rely on your memory or some notes that you scratched-down. If you have a grievance, just the fact that you can offer up a transcript might get them to relent. And if you go in front of a judge, having a recording will go a lot farther than your recollection in getting a decision in your favor.
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Old 09-05-2014, 09:06 PM   #104
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Yes, back on topic. We don't know yet what premiums will be for 2015. Hope for the best but prepare for the worst, so I'm doing some of the leg work now.
Good idea, but are the 2015 Plans finalized in your region? In some states, insurers can submit plans for rate approval, then withdraw or modify the plans if the approved rates are too low. That can be a last-minute decision by the carrier. I suspect for many of us, most of the research will have to wait until shortly before OE 2015 begins.

BTW- Can't help with the Humana "elective surgery" definition. Humana is not offering plans in my region. Generally, "elective" means anything the carrier does not deem to be "medically necessary" under its policies/rules, like cosmetic or reconstructive. IIRC, ACA does not mandate coverage for most reconstructive surgery.
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Old 09-05-2014, 09:14 PM   #105
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I take it they do not define "elective surgery?" Does this mean they won't pay for a nose job, or they won't pay for, say, gall bladder removal?

You wrote what I was thinking, Brewer. Except I was thinking... Your heart transplant has been ruled elective. Dying is natural and inevitable.


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Old 09-06-2014, 06:45 AM   #106
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Good idea, but are the 2015 Plans finalized in your region? In some states, insurers can submit plans for rate approval, then withdraw or modify the plans if the approved rates are too low. That can be a last-minute decision by the carrier. I suspect for many of us, most of the research will have to wait until shortly before OE 2015 begins.
No information on 2015 plans will be available until open enrollment begins. I will be reviewing current plans because 1) they are the only ones available for review and 2) my expectation is they will mostly be the same ones offered for 2015. If I'm wrong I wasted some time, NBD for an old retired guy.

The insurer's websites for individuals could not carry the load last year. This may have changed but I see no reason to bet on it.
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Old 09-07-2014, 09:42 PM   #107
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Here's a data point for those keeping score at home.

DW and I are still on our Pre-ACA plan with UNH. Rates were just increased 19.33%. That's following increases of 24.44% and 17.95%. This is a highest deductible plan(10K or so) with an HSA. (also individual - family plan, not group).

I briefly looked at the ACA plans last year and the headline number of this plan was cheaper than the bronze ACA plan. My difficulty is that ACA plans are not multistate yet (AZ and UT), so I am sticking with UNH while they stick it to me!
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Old 09-08-2014, 11:36 AM   #108
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Here's a data point for those keeping score at home.

DW and I are still on our Pre-ACA plan with UNH. Rates were just increased 19.33%. That's following increases of 24.44% and 17.95%. This is a highest deductible plan(10K or so) with an HSA. (also individual - family plan, not group).

I briefly looked at the ACA plans last year and the headline number of this plan was cheaper than the bronze ACA plan. My difficulty is that ACA plans are not multistate yet (AZ and UT), so I am sticking with UNH while they stick it to me!
There are multi-state plans available on the ACA, at least in my state.
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Old 09-08-2014, 11:52 AM   #109
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Multi-State plans are plans with identical coverage and terms, registered in multiple / most state, and designed for businesses that want to offer the identical plan to employees residing in different states.

Multi-state networks, which I suspect is the intent of Utah Skier's post, are insurance networks that cover policyholders across the country or outside of the immediate region where they reside. There is no ACA requirement that insurers offer networks with multi-state or nation-wide coverage. They seem to be available in most areas and are certainly a requirement for many of us that travel extensively or don't spend the year in one single location.

One of the most attractive features (IMHO) of Medicare is the nation-wide coverage.
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Old 09-08-2014, 11:00 PM   #110
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In my region there are only 2 Plans with multi-state coverage, both Silver with no HSA option. I am hoping this will change for 2015.
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Old 10-16-2014, 10:50 AM   #111
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I just received my HI info for 2015. Premiums for my catastrophic plan increased 6.8%. Deductible increased 3.9% but I'm less concerned about that as we never come close to meeting it.

The bronze plan we were on the first half of the year increased premiums by 5.7%.

Not bad and actually quite a bit less than the last couple years.
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Old 10-16-2014, 11:37 AM   #112
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I just received my HI info for 2015. Premiums for my catastrophic plan increased 6.8%. Deductible increased 3.9% but I'm less concerned about that as we never come close to meeting it.

The bronze plan we were on the first half of the year increased premiums by 5.7%.

Not bad and actually quite a bit less than the last couple years.

I wish I could say the same thing, PB. Just got my letter saying my plan is going from $88 to $375. My calculator doesn't work on percentage increases that high. I am officially a causality of the "if you like your plan you can keep it" promise. Info is still skimpy as they said it was a similar but "off exchange" plan. My state will not release exchange pricing until Nov. 15, so I will wait and see if I can find a cheaper plan than that, since I do not use medical services other than NyQuil occasionally.


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Old 10-16-2014, 12:15 PM   #113
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$375 would align with what our bronze plans run. Since you don;t use medical services other than NyQuil occasionally, I suggest you look into catastrophic plans. In our case, the deductible was a bit higher but the premiums were 37% less.
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Old 10-16-2014, 01:21 PM   #114
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$375 would align with what our bronze plans run. Since you don;t use medical services other than NyQuil occasionally, I suggest you look into catastrophic plans. In our case, the deductible was a bit higher but the premiums were 37% less.

I will look at that, but I will probably have to dig as ehealthinsurance wouldn't even show me a price since I was over age 30. The rules have clearly changed since I can claim hardship by being kicked off my plan. I really wanted to avoid messing with the actual exchange itself since I will receive no subsidy.


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Old 10-16-2014, 03:49 PM   #115
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Yes, it is a bit of work for those over 30 even if they clearly qualify, but in our case a 37% premium savings was well worth the inconvenience. I didn't have the option to avoid the exchange.
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Old 10-16-2014, 03:52 PM   #116
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As far as I can tell, in Texas we still have no clue about what the proposed rate changes were, let alone anything finalized or approved.
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Old 10-16-2014, 04:21 PM   #117
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BCBS Fl released their 2015 prices a few weeks ago. The national PPO plans are all up 22%. Add another 5% for the age bump. I believe my $$ increase may be just as much as Mulligan's.
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Old 10-16-2014, 07:16 PM   #118
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As far as I can tell, in Texas we still have no clue about what the proposed rate changes were, let alone anything finalized or approved.

If what I read is correct, all federal ran exchanges are on lock down with no release until it's open. They are not supposed to comment on effectiveness of the web site either... Wanted all the info to be kept out of the election process to prevent any possible voter "backlash" is what I read.


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Old 10-16-2014, 08:46 PM   #119
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If what I read is correct, all federal ran exchanges are on lock down with no release until it's open. They are not supposed to comment on effectiveness of the web site either... Wanted all the info to be kept out of the election process to prevent any possible voter "backlash" is what I read.


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Similar rumors in my area. Plans and rates are apparently already set, but not for public release until mid-Nov. The motivation is clearly NOT to help ave citizens with their 2015 financial planning
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Old 10-16-2014, 09:04 PM   #120
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Similar rumors in my area. Plans and rates are apparently already set, but not for public release until mid-Nov. The motivation is clearly NOT to help ave citizens with their 2015 financial planning
Politick much?
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