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Old 07-27-2013, 09:50 PM   #121
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While I agree that things like mobile app support are just "nice to haves", there are important support issues consumer won't get for 2013-4 roll-out. We're all familiar with the repetitive statements from Admin (inc Obama) that under ACA you can "keep your own doctor". How do you know if you cannot check on your Exchange? Prompt updates for life-changing events (like baby's birth) are rather critical to obtaining care under your HI as many providers & facilities require such documentation prior to providing (even scheduling) non-emergency care. Specific details regarding costs associated with specific plans are obviously important in making informed decisions. Boston.com article indicates that these Exchange features which I (& IMHO many other folks) would consider key are not going to be there for initial Open Enrollment period--at least in the states cited.
And re Federal Exchange- "For the federally run exchanges, officials said the calculator will automatically subtract the consumer’s tax credit from plan premiums — a help. But it won’t provide an estimate of likely out-of-pocket costs that the plan doesn’t cover, a feature consumer advocates say is closer to the true bottom line."
IMHO- Knowing my potential out-of-pocket costs is absolutely essential in deciding on ANY insurance product, whether HI, auto, homeowners, or whatever. I get that info with my current employer-sponsored HI so I have no idea why it cannot be provided by Fed Exchange.

Agree 100% with Ziggy that it will likely take a yr or two to work out the bugs with the Exchanges. But some of the shortcomings being discussed in the media would be more than mere bugs. I truly hope that Dem Senator Baucus is wrong is his fear that ACA OE could be a "train wreck".
Max Baucus worried about health law 'train wreck' - Jennifer Haberkorn - POLITICO.com
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Old 07-28-2013, 04:41 AM   #122
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Some of those fears will surely materialize, and I'm pretty sure some won't.
Just like some of the fears about what would have happened without ACA would have materialize and others wouldn't have. Discussion of fears is pretty meaningless. It just serves fear, and curmudgeony, not people.
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Old 07-28-2013, 10:06 AM   #123
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Discussion of fears is not meaningless in that it may adversely drive human behavior. Most pundits, and the Administration itself, believe the Exchanges must deliver enough functionality to attract a critical mass of participation by currently uninsured young adults. If fears about inadequacy/complexity of ACA Exchanges cause most of them to not participate, most all agree it will be a major fiscal problem for the new HI system.

Reliable info on what features will not be in the Exchanges during '13 OE is not fear mongering, but useful (even necessary) information for those needing individual HI under the program. It appears the Exchanges will NOT be "one-stop shopping" for HI as gov't (e.g. Cong Res Svc) has repeatedly claimed.
http://www.fas.org/sgp/crs/misc/R42663.pdf
Somehow I am not reassured that HHS will be providing phone service back-up for support, since it appears these newly hired folks will be mainly ex-telemarketers reading from prepared scripts-
Employment ads for the call centers' "temporary customer service representatives" seek applicants who have a high school diploma or equivalent and six months of telemarketing or secretarial experience.
"An HHS spokeswoman said that customer service representatives will answer questions by reading from HHS-approved scripts and provide state-specific information. However, she would not provide examples of the scripts or say whether they were tested with consumers."
http://www.healthcareitnews.com/news/insurance-exchange-poses-new-challenge?single-page=true
Bottom line: Folks need to prepare to do their own research BEYOND the Exchanges regarding Plans they are considering, inc. specific docs/facilities participating, anticipated out-of-pocket costs, how to PROMPTLY register important life events (birth, marriage, etc.), etc. Since IRS works much the same way, not sure we should be all that surprised by this The more folks understand the reality of the Exchanges, the better the system will function.
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Old 07-29-2013, 03:34 AM   #124
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I agree with your Bottom line, though not with your premise for how you got there. We'll have to settle for that.
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Old 07-30-2013, 06:40 AM   #125
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Why do folk worry about who their doctor is and wanting to keep them? Unless of course they are a close family member. When you change your home state you have to get a new doctor.

Methinks it is kind of like the Blue Pill Syndrome. "I have been taking a blue pill now you give me a pink one, I want my blue one". Habit over practicality. If we have to change a doctor because of coverage, (E.G. Current Doc does not accept Medicare Patients) So be it.

Personally I do not really care, doctors are like car mechanics, you get one you like, you stick to it. You get a bad one, you find a new one, you move you find a new one.

We have moved so many times and had so many doctors it is not funny, but we always find one we like in the new place.
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Old 07-30-2013, 09:18 AM   #126
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Glad you have been able to find good docs over the years who (presumably) participate in your HI. Unfortunately, many (inc me) have found it harder to find a good doc than a good mechanic. IMHO- Increasing market competition will likely result in providers & facilities moving in & out of networks more frequently, so having updated and accessible info on network info will be more important than ever.
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Old 07-30-2013, 09:43 AM   #127
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Shok-
Glad you have been able to find good docs over the years who (presumably) participate in your HI. Unfortunately, many (inc me) have found it harder to find a good doc than a good mechanic. IMHO- Increasing market competition will likely result in providers & facilities moving in & out of networks more frequently, so having updated and accessible info on network info will be more important than ever.
We have been lucky, but also out circumstances could be taken into consideration. And by the way I have fired a few docs in my time too.

Although I have a pacemaker and am on Blood pressure meds, I still manage to only go to the doctor 4 - 5 times per year. 2 of those are routing pacer checks the others may be to tweak my BP meds.

I guess if you go a lot you may want to see the same person. I still think for the most part it is the Blue pill vs Pink pill syndrome.

We all have our reasons. But we are so used to changing it does not bother me at all.
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Old 07-30-2013, 11:28 AM   #128
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Shok-
Glad you have been able to find good docs over the years who (presumably) participate in your HI. Unfortunately, many (inc me) have found it harder to find a good doc than a good mechanic. IMHO- Increasing market competition will likely result in providers & facilities moving in & out of networks more frequently, so having updated and accessible info on network info will be more important than ever.
Indeed, I have had to drill it into DW's head to confirm a provider is "in network" before making an appointment. It's a bit of a hassle, as if finding a good doctor wasn't sometimes hard enough already...
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Old 07-31-2013, 12:21 PM   #129
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Obamacare scores breakthrough on exchanges - Yahoo! Finance

Why it took them so long...I have way more confidence in ehealthinsurance.com than I do the Fed. of handling the customer end....
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Old 07-31-2013, 01:19 PM   #130
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Obamacare scores breakthrough on exchanges - Yahoo! Finance

Why it took them so long...I have way more confidence in ehealthinsurance.com than I do the Fed. of handling the customer end....
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They certainly have the experience and the framework to handle something like this, provided they can scale it up well with a lot more users starting on October 1. They can probably do it cheaper and more efficiently than creating a new bureaucracy to build and manage it.

I do think it needs to be reviewed periodically to make sure they are adequately serving the health insurance consumer and that their cut of the take remains reasonable and competitive.
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Old 07-31-2013, 02:35 PM   #131
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Interesting. I wonder how this will affect the underwritten policies they sell. This might make it a bit more difficult for insurers to refuse to participate in the exchanges.

This will allow us to make direct comparisons of the user interface, information presentation, buying process, etc, for the same policy in the same state. That will be fun.
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Old 07-31-2013, 03:47 PM   #132
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They [eHealth.com] certainly have the experience and the framework to handle something like this, provided they can scale it up well with a lot more users starting on October 1. They can probably do it cheaper and more efficiently than creating a new bureaucracy to build and manage it.

I do think it needs to be reviewed periodically to make sure they are adequately serving the health insurance consumer and that their cut of the take remains reasonable and competitive.
From the article:
Quote:
The deal could also earn eHealth a lot of money. The online insurance giant gets an average premium of about 7 percent for the plans it offers on its website, in the form of commissions paid by the insurance providers who sell the plans.
There's no indication in the article of what is in this deal, but if insurers are required to spend 80% of premiums to pay medical expenses, and if they give 1/3rd of the remainder to eHealth in commissions, that leaves a pretty thin slice for the insurance companies to use in dealing with claims, dealing with providers, maybe giving a dividend to shareholders, etc. Perhaps the government is paying eHealth.com directly with the hundreds of millions of dollars HHS was given to perform this function.
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Old 07-31-2013, 03:56 PM   #133
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From the article:
There's no indication in the article of what is in this deal, but if insurers are required to spend 80% of premiums to pay medical expenses, and if they give 1/3rd of the remainder to eHealth in commissions, that leaves a pretty thin slice for the insurance companies to use in dealing with claims, dealing with providers, maybe giving a dividend to shareholders, etc. Perhaps the government is paying eHealth.com directly with the hundreds of millions of dollars HHS was given to perform this function.
I could be wrong but I thought the usual arrangement for sites like this was a percentage of the premiums in the *first year*. In other words, a policy that has a total cost of $10K per year would net them $700 -- but only in the first year. If so and if people don't "plan hop" that often, it might not be a huge chunk in the grand scheme of things.
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Old 07-31-2013, 04:41 PM   #134
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I could be wrong but I thought the usual arrangement for sites like this was a percentage of the premiums in the *first year*. In other words, a policy that has a total cost of $10K per year would net them $700 -- but only in the first year. If so and if people don't "plan hop" that often, it might not be a huge chunk in the grand scheme of things.
That was the first thought that hit my mind when I read the link...Great, another 7% slapped on top of my already soon to be bigger premium. It won't be an additional tax, it will be a "consumer convenience service charge" On a serious note, it did also make a reference to savings, so maybe it is one of those situations where on the technological end of things it costs some money, to save more money.
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Old 07-31-2013, 04:54 PM   #135
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My recollection is the insurers will pay a 2% fee to the exchanges. If so, any additional charge by e-health would make the policy cost more. It seems unlikely this agreement will result in a higher price for the same policy.
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Old 07-31-2013, 05:23 PM   #136
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My recollection is the insurers will pay a 2% fee to the exchanges. If so, any additional charge by e-health would make the policy cost more. It seems unlikely this agreement will result in a higher price for the same policy.
And even if it *were* 7% (which I don't they'd get in a larger and more captive audience), it is probably only for the first year. Or else they get it on an ongoing basis but only as long as the policy is in force (meaning they wouldn't profit more from plan-hopping).

It may be a model like the cruise lines and tour operators have with travel agents (and what airlines and hotels *used* to have). The price is the same whether you use them or not, but if you use a marketer like a travel agent (or perhaps this site), a percentage of the first-year premium is eaten in commission.

The airlines and hotels no longer use this model, but cruise lines (mostly) still do.
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Old 07-31-2013, 08:58 PM   #137
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I do think it needs to be reviewed periodically to make sure they are adequately serving the health insurance consumer and that their cut of the take remains reasonable and competitive.
I certainly agree.

One question I have relates to this quote from the CEO.
EHealth Wins Approval to Sell Obamacare Health Plans - Bloomberg
Quote:
EHealth collects about 7 percent of monthly premiums as commission for the plans it sells now, Lauer said. Carriers will probably negotiate a lower commission for plans sold in government exchanges because “the risk is a little bit more unknown,” he said.

Under the agreement with the government, EHealth must offer customers any plan available on the federal exchanges, regardless of whether it has a commission agreement with the carrier.

“I’m happy to enroll someone if we don’t get a commission for it,” Lauer said.
So, why would an insurer pay ehealth_.com a commission? Or, said another way, what will the commission-paying insurer get for his money?

I worry that the expected the easy-to-navigate comparison features, cost comparison tables and handy links to individual plan details will only be data from the "preferred" providers paying the commissions.

EDGAR posted the agreement between HHS and ehealthinsurance.com.
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It's very high-level, and doesn't say much about data presentation requirements.

The agreement does reference CFR requirements for brokers, so I dug a little more.

These are the basic requirements. I feel a little better, since the highlighted language requires that data from all exchange-approved plans be available.

Perhaps I'm being too skeptical, but I'd feel even better if there was something in the contract or the regs explicitly requiring the data for all the plans to be consistently presented.

45 CFR 155 : EXCHANGE ESTABLISHMENT STANDARDS AND OTHER RELATED STANDARDS UNDER THE AFFORDABLE CARE ACT [ 45 CFR 155 ] : (PUBLIC WELFARE [ 45 CFR ])
Quote:
§ 155.220 Ability of States to permit agents and brokers to assist qualified individuals, qualified employers, or qualified employees enrolling in QHPs...

(c) Enrollment through the Exchange. A qualified individual may be enrolled in a QHP through the Exchange with the assistance of an agent or broker if—
(1) The agent or broker ensures the applicant's completion of an eligibility verification and enrollment application through the Exchange Web site as described in §155.405;
(2) The Exchange transmits enrollment information to the QHP issuer as provided in §155.400(a) to allow the issuer to effectuate enrollment of qualified individuals in the QHP.
(3) When an Internet Web site of the agent or broker is used to complete the QHP selection, at a minimum the Internet Web site must:
(i) Meet all standards for disclosure and display of QHP information contained in §155.205(b)(1) and (c);
(ii) Provide consumers the ability to view all QHPs offered through the Exchange;
(iii) Not provide financial incentives, such as rebates or giveaways;
(iv) Display all QHP data provided by the Exchange;
(v) Maintain audit trails and records in an electronic format for a minimum of ten years; and
(vi) Provide consumers with the ability to withdraw from the process and use the Exchange Web site described in §155.205(b) instead at any time.

§ 155.205 Consumer assistance tools and programs of an Exchange.

(b) Internet Web site. The Exchange must maintain an up-to-date Internet Web site that meets the requirements outlined in paragraph (c) of this section and:
(1) Provides standardized comparative information on each available QHP, including at a minimum:
(i) Premium and cost-sharing information;
(ii) The summary of benefits and coverage established under section 2715 of the PHS Act;
(iii) Identification of whether the QHP is a bronze, silver, gold, or platinum level plan as defined by section 1302(d) of the Affordable Care Act, or a catastrophic plan as defined by section 1302(e) of the Affordable Care Act;
(iv) The results of the enrollee satisfaction survey, as described in section 1311(c)(4) of the Affordable Care Act;
(v) Quality ratings assigned in accordance with section 1311(c)(3) of the Affordable Care Act;
(vi) Medical loss ratio information as reported to HHS in accordance with 45 CFR part 158;
(vii) Transparency of coverage measures reported to the Exchange during certification in accordance with §155.1040; and
(viii) The provider directory made available to the Exchange in accordance with §156.230.

c) Accessibility. Information must be provided to applicants and enrollees in plain language and in a manner that is accessible and timely to—
(1) Individuals living with disabilities...

(2) Individuals who are limited English proficient...
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Old 08-01-2013, 06:46 AM   #138
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So, why would an insurer pay ehealth_.com a commission? Or, said another way, what will the commission-paying insurer get for his money?
Exposure to consumers who can be directed to the website through commercial advertising through means that perhaps the exchanges aren't going to stoop to.
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Old 08-01-2013, 07:23 AM   #139
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Exposure to consumers who can be directed to the website through commercial advertising through means that perhaps the exchanges aren't going to stoop to.
Or that the federal exchanges can't afford to run...

The business side of the fall sign-up scramble will be fascinating. In the big picture of this massive change, the objective is to increase the aggregate number of individuals signing up with health insurers. From an individual company's perspective, however, the objective is to sign up a pool of new customers with a profitable risk profile relative to the premiums charged. Healthy customers is what they want.

One marketing scenario that meets the insurer's objectives and might have a payoff worth paying the commission is that ehealthinsurance would pledge to skew their marketing to the "young invicibles" and other groups less likely to bring high claims rates. There is already an inherent tendency in that direction, given young people's greater comfort and experience in online purchasing.
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Old 08-01-2013, 09:13 AM   #140
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One marketing scenario that meets the insurer's objectives and might have a payoff worth paying the commission is that ehealthinsurance would pledge to skew their marketing to the "young invicibles" and other groups less likely to bring high claims rates. There is already an inherent tendency in that direction, given young people's greater comfort and experience in online purchasing.
So the strategy would be to sign up at places marketing to these "young invincibles" and not the ones advertising in AARP Magazine?
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