ACA sign Up

[jflynn4]

Anyone who is currently having major health issues and thinking of switching from their current individual health insurance plan to an Affordable Care Act insurance plan better do their homework first. I was diagnosed with multiple myeloma (a blood cancer) in June and will be undergoing a stem cell transplant in late December and going into early January. I was talking with the financial/insurance person with the group of doctors where I will be getting my stem cell transplant and was told that as of this week they would NOT be accepting any of the Affordable Care Act health insurance plans (Cigna, BCBS/TX and Aetna in the Dallas area) for a stem cell transplant. I was told that if I switched to one of those plans I would have to find someone else to do the transplant...or pay for it myself. So for now I've decided to stick with the Cigna health insurance plan that I currently have. I could probably find someone else to do the transplant but the group and hospital I'm looking at to do it is one of the best in the Dallas area and saving a few $grand is probably not my highest priority at this point. Luckily Cigna sent me a letter a month ago saying that my plan would remain the same in 2014 because the effective date of the plan would be 12/31/2013 rather than 01/01/2014...which means that they didn't have to meet all of the Affordable Care Act requirments. The only change was that my premium went up from $406/mo to $465/mo. I would have liked to have switched to an Affordable Care Act gold plan because my deductible would have been $2000-3000 less and my premium would have been about $80/month less....about a $3000-4000 savings over my current plan. But if I switched I'd be limiting myself to where I could get my health services. So if you're having any major health related services done next year and have a choice as to whether you keep your current plan or switching, you might want to do some research to find out who will be accepting those new Affordable Care Act plans. I would hope that by a year from now more health groups would be accepting the Affordable Health Care plans for more health services after they know more details. Hopefully I can switch to an Affordable Care Act plan a year from now and be able to use the same doctors and hospitals I can use today.

So they are saying that they will no longer accept plans that are ACA compliant? That seems almost impossible in the years ahead since ALL plans are going to be such once the employer mandate hits.

 

[MRG]

So they are saying that they will no longer accept plans that are ACA compliant? That seems almost impossible in the years ahead since ALL plans are going to be such once the employer mandate hits.

I think it's about the network. You probably know the ACA networks are typically smaller. In my area the biggest provider is 'just saying no', to ACA exchange plans.

I'm hopeful this will change over time.

MRG

 

[jflynn4]

I think it's about the network. You probably know the ACA networks are typically smaller. In my area the biggest provider is 'just saying no', to ACA exchange plans. I'm hopeful this will change over time. MRG

I've read the comments regarding smaller networks, etc., but am really confused on that. As of January 2015, ALL insurance plans will be ACA mandatory, not just those sold thru the exchange. Looking at the BCBS of Florida website, as an example today, the HMO plan is listed under their "Blue Care" network. That network remains the same when looking for physician or hospital whether you purchase thru the exchange or directly from them. (I actually called them to confirm this).

Just very confusing and I'm guessing that confusion may well get worse in the months to come.

 

[MRG]

Here we have the Blue Select network for most of BCBS ACA plans, it covers 5 counties. There is another slightly larger BCBS national network, but it's not near the size of the 'traditional' BCBS network.

I too am hopeful this gets fixed. Or maybe its time to move, FL can be nice.

MRG

 

[DallasGuy]

So they are saying that they will no longer accept plans that are ACA compliant? That seems almost impossible in the years ahead since ALL plans are going to be such once the employer mandate hits.

My guess is that it isn't so much as to which plans are ACA compliant but the amounts that each plan reimburses the doctors/hospitals for their services. I'm guessing that the ACA plans probably pay less at this point. My other guess would be that the doctor's groups may not know what the reimbursements are for the ACA plans yet and have simply decided not to accept them until they have more details. But these are just guesses on my part. I would hope that after the ACA plans are up and running that they would eventually be accepted by more doctors.

 

[tinlizzy]

I think it's about the network. You probably know the ACA networks are typically smaller. In my area the biggest provider is 'just saying no', to ACA exchange plans.

I'm hopeful this will change over time.

MRG

Here, also (Iowa). BCBS decided not to participate. Coventry Health was the only insurer signed on in Iowa and then along came a retired insurance executive and a former state insurance commissioner who decided to form a co-op - Midwest Members Health.

Health insurance co-op may be golden ticket

Newsroom: health insurance, Iowa, Nebraska: CoOportunity Health

They bought the rights to use Midland's Choice network which had 90% of Iowa doctors and hospitals signed up and then partnered with the Nebraska and Iowa Credit Union league and finally U of I Health Alliance.

I sure hope these co-op's take off because they look very promising.

 

[47]

So they are saying that they will no longer accept plans that are ACA compliant? That seems almost impossible in the years ahead since ALL plans are going to be such once the employer mandate hits.

It is not because it is ACA compliant. They are not taking the plans that are sold within the exchange.

An insurer can have an ACA compliant plan and choose to not offer it inside the exchange. ACA mandates such thing as no-pre existing conditions, no annual cap or lifetime cap, minimum coverage according to 10 commandments(!), no discrimination based on gender etc.

But to play within the exchange, they have to standardize in and conform to one of the metal levels, where they can be compared head to head against other offerings. Also only within the exchange all the unwashed masses who didn't have insurance before and all those who need subsidies.

The insurance companies hate this because it lays bare their pricing. They would rather confuse and obfuscate the pricing structure so that they can use their marketing muscle to push their plans.

That's the reason they are not fully participating in the exchange and hence the poor coverage of provider network for exchange plans currently. Hopefully it will improve in the coming years.

 

[Gatordoc50]

I am puzzled by the claims that certain providers may not accept exchange plans. I wonder if it has to do with the high deductibles. After all, the uninsured have historically not paid their doctor bills. Even people who make over 400% FPL only pay 37% of their bill. Those under 400% pay a whopping 12%. So, the hospital performs 5 grand in services and receives a pittance after years of billing and administrative costs. No thanks.

 

[MRG]

I asked my DR. last visit, he said 'HCA has chosen not to participate in these low end ACA plans'. I assumed he meant the high deductible plans.

After talking with the insurer, HCA was in no networks available through the exchange. I take that to mean the margins were to small. YMMV.

MRG

 

[bamsphd]

I am puzzled by the claims that certain providers may not accept exchange plans.

In my state Anthem (BCBS) created a new network for their exchange plans, and basically told all the providers they would have to offer great prices to be in the Anthem exchange network. The carrot was that the Anthem exchange network would be an EPO style network, so the providers would get more volume. This year Anthem is our state's only exchange provider for medical, so as far as I can tell everyone signing up on the exchange for medical is in the Anthem exchange network regardless of Bronze, Silver, or Gold plan selected. There were lots of news reports about the many hospitals excluded from the new network, including one of the two hospitals in my home town. The local hospital outside the network is the same hospital which United Health Care dropped fifteen years ago for a year or two because of failed price negotiations.

As far as I know, the only other provider in our exchange is Delta Dental who is offering an EPO alternative to Anthem's dental plans. As of yesterday, my dentist said their practice had still not opted in to the Delta Dental EPO plan. They are in the non-exchange Delta Dental PPO plan, but had not yet received information from Delta Dental regarding what compensation they would have to accept if they became an EPO provider.

The other thing my dentist told me surprised me, and I have not yet been able to confirm it. The dentist claimed that our state government's insurance agency had required all the exchange plans to be HMO/EPO style plans instead of PPO plans. If that is true, I am truly annoyed with my state government.

 

[sengsational]

Here, also (Iowa). BCBS decided not to participate. Coventry Health was the only insurer signed on in Iowa and then along came a retired insurance executive and a former state insurance commissioner who decided to form a co-op - Midwest Members Health.

Health insurance co-op may be golden ticket

Newsroom: health insurance, Iowa, Nebraska: CoOportunity Health

They bought the rights to use Midland's Choice network which had 90% of Iowa doctors and hospitals signed up and then partnered with the Nebraska and Iowa Credit Union league and finally U of I Health Alliance.

I sure hope these co-op's take off because they look very promising.

This does sound promising. Rather than be seen as a source of revenue by shareholders, the policy buyers would be owners. And maybe that would mean, as an owner, you could see the contracts between the group and the service providers...something that insurance companies hide from policy holders.

 

[lemming]

Did everyone have to send in verification of identity? Because I never got asked to do so...
I got through the process last week,slow but sure until the last step where it said pay now. and no link to Kaiser. I have a confirm # and a congratulations message so I will give it some time and make sure I get payment in to them.
I went with Kaiser, more expensive then BC but then I know there are doctors there that take the insurance,they are the insurance. And I have heard people brag on the system.

 

[audreyh1]

Here we have the Blue Select network for most of BCBS ACA plans, it covers 5 counties. There is another slightly larger BCBS national network, but it's not near the size of the 'traditional' BCBS network.

I too am hopeful this gets fixed. Or maybe its time to move, FL can be nice.

MRG

For Texas it's listed as BlueChoice PPO and they make no distinction between plans. There is only one place to look up doctors for BlueChoice PPO - they don't ask for plan specifics. I sure hope this doesn't change.

 

[ziggy29]

Did everyone have to send in verification of identity? Because I never got asked to do so...

If they were able to successfully verify your identity online based on the questions you were given, it appears they don't ask for it.

 

[lemming]

Thanks Ziggy I forgot about those few strange questions about old phone #s.
Now if I just get the call to send them money I'm set. Never been so eager to pay a bill.

 

[ziggy29]

This does sound promising. Rather than be seen as a source of revenue by shareholders, the policy buyers would be owners. And maybe that would mean, as an owner, you could see the contracts between the group and the service providers...something that insurance companies hide from policy holders.

Quite a few P&C and Life insurers are mutuals (owned by policyholders), but to my knowledge that's not usually been true in the health insurance industry.

 

[pb4uski]

CBS had a feature on this website that provides easier access to health insurance exchange data. Note that some states that are not on the federal website are not included yet but it looks pretty user friendly to me. The feature indicates that a few young gurus put it together over a weekend.

HealthSherpa

 

[MichaelB]

Alternative to healthcare.gov

There’s been some discussion whether premium assistance and subsidies can only be obtained using healthcare.gov to get insurance. This CMS memo http://www.in.gov/idoi/files/agent-broker-5-1-2013.pdf (tip of the hat to rbmrtn), lays out the process that allows policies with tax credits and subsidies to be obtained elsewhere, specifically web-brokers and some issuers.

Agents and brokers intending to work with consumers in Federally-facilitated and State Partnership Marketplaces will be able to assist consumers in two ways: (a) an issuer-based pathway, through which an agent or broker uses an issuer’s website to assist the consumer; or (b) a Marketplace pathway, through which an agent or broker assists the consumer using the Marketplace website.

There are two paths. One is for an agent or broker to simply assist the consumer, but still following a path where the consumer establishes the healthcare.gov account. A second path exists where the issuer has a separate interface to the healthcare.gov system that is used to establish assistance eligibility, but the rest of the front end consumer enrollment activity is carried out on the insurer’s system. Page 11 shows the issuer based pathways process flow.

Some insurers are now capable of this, and we have one report of a successful enrollment. This looks to be a workable options for some. What policies are available can be found on the healthcare widget. Websites like valuepenguin (here) and healthsherpa (here) can give useful pricing estimates, and many insurers now have all of their 2014 policy info online. One call to the insurer will confirm if their enrollment process enables subsidy.

 

[47]

CBS had a feature on this website that provides easier access to health insurance exchange data. Note that some states that are not on the federal website are not included yet but it looks pretty user friendly to me. The feature indicates that a few young gurus put it together over a weekend.

HealthSherpa

BRAVO..

The numbers I get from Health Sherpa are spot on accurate, and also seem to be complete as far as the exchange plans go.

So if you are considering using the exchange either for subsidy, or for philosophical reasons, and have been stymied by the mechanics, this site allows you to get a rate quote in about 30 seconds. The only variable is the estimate you give for 2014 income. That uncertainty is there everywhere.

Of course, this is only for getting an idea on the choices, price, and subsidy. To actually sign up, you need to go through a process -- either online or through paper work. But this is a fantastic start.

One thing I thought was missing on the Healthsherpa site was the actual benefits associated with the various metal levels -- deductibles, OOP max amounts, copays for various procedures etc. If it is there, I didn't find it in the brief time I spent on it.

 

[Texas Proud]

CBS had a feature on this website that provides easier access to health insurance exchange data. Note that some states that are not on the federal website are not included yet but it looks pretty user friendly to me. The feature indicates that a few young gurus put it together over a weekend.

HealthSherpa

Thanks for the link...

The big problem I see with the plans offered are almost all are HMOs...

The first PPO is catastrophic and is more expensive... the first bronze PPO is $220 per month more than the HMO...

That is a big expense to keep out of an HMO.... and my experiences with HMOs have been bad...

 

[Cedar]

Thanks for the link...

The big problem I see with the plans offered are almost all are HMOs...

The first PPO is catastrophic and is more expensive... the first bronze PPO is $220 per month more than the HMO...

That is a big expense to keep out of an HMO.... and my experiences with HMOs have been bad...

I am signed up under an HMO and there are more providers listed with the HMO network then PPO offered through another insurer. I think everyone agrees that something is needed to curb the outrageous raising cost of health care and I am grateful that we are having this discussion and something is being done for a change.

 

[jflynn4]

I am signed up under an HMO and there are more providers listed with the HMO network then PPO offered through another insurer. I think everyone agrees that something is needed to curb the outrageous raising cost of health care and I am grateful that we are having this discussion and something is being done for a change.

Unfortunately, the ACA really does nothing to curb the rising cost of health care...it simply spreads that cost out among others and, has been widely reported, there will be some "winners" and some "losers" in the process.

Until individuals really start to bear some of the actual costs involved in the healthcare process, dealing in their own funds, it's going to be very difficult to see the cost curve bend downward. In the current process, and this continue under the ACA, there is little opportunity (due to limited networks) and even less incentive (since premiums can be maxed out at a percentage of income) to "shop around" for healthcare services.

For the purposes of ER though, many of us will be "winners" in the process, paying significantly less under the ACA than we would have otherwise under standard private care (particularly since many of us can "manage" our income levels to stay under the threshold for subsidies.

 

[Mulligan]

Unfortunately, the ACA really does nothing to curb the rising cost of health care...it simply spreads that cost out among others and, has been widely reported, there will be some "winners" and some "losers" in the process. Until individuals really start to bear some of the actual costs involved in the healthcare process, dealing in their own funds, it's going to be very difficult to see the cost curve bend downward. In the current process, and this continue under the ACA, there is little opportunity (due to limited networks) and even less incentive (since premiums can be maxed out at a percentage of income) to "shop around" for healthcare services. For the purposes of ER though, many of us will be "winners" in the process, paying significantly less under the ACA than we would have otherwise under standard private care (particularly since many of us can "manage" our income levels to stay under the threshold for subsidies.

I read an interesting article today that made a point with me and a chuckle since I am guilty as charged. The line was something to the effect of "to get a true control over healthcare costs, we need to switch from the current argument over who is paying for whose health insurance and get to the true problems that are causing the cost problems."
It appears that the bad economy over the recent years has slowed the rate increases due to higher deductibles and people just not having money to address medical needs if needed. But, this is only my opinion, I believe has only temporarily slowed the problem down. The cost issues are deeper than this. Cutting doctors pay isn't an answer to me, and we don't seem to have a desire to push granny over the cliff, so someone with more intelligence than me will have to solve it. But there sure seems to be answers out there based on other modernized countries whose per person cost for care is considerably cheaper.

 

[47]

Unfortunately, the ACA really does nothing to curb the rising cost of health care...it simply spreads that cost out among others and, has been widely reported, there will be some "winners" and some "losers" in the process.

Until individuals really start to bear some of the actual costs involved in the healthcare process, dealing in their own funds, it's going to be very difficult to see the cost curve bend downward. In the current process, and this continue under the ACA, there is little opportunity (due to limited networks) and even less incentive (since premiums can be maxed out at a percentage of income) to "shop around" for healthcare services.

I take a longer view. Yes, you are correct in that ACA spreads the cost around in terms of winners and losers. But shopping for insurance is not quite the same as shopping for healthcare.

CONSUMERS: As ACA has made the cost of insurance transparent and comparable, people are going to be jumping in (relatively speaking) a bit more onto lower cost, higher deductible plans. Well, that in turn makes them more aware of their usage of healthcare and it can only help to slow the rate of healthcare inflation.

HEALTH CARE INDUSTRY: Also, I think you are underestimating the effect of provider network shopping that is going on in choosing the insurance plan. It is well known that people are not very good at shopping for doctors when the need is immediate. If you are in pain and need to have an appendix removed, you are going to go to the best doctor you can find, cost be damned. But when you are shopping for insurance, the cost is a bigger factor and as long as the provider network passes some basic threshold you would be okay with it. This is going to put downward pressure on the cost such as lab cost, doctor salaries, hospital efficiency etc.

INSURANCE COMPANIES: The other leg of this three legged stool is the insurance companies themselves. They too will feel the pinch as they have to get adjusted to head to head comparison shopping. If one of the smaller companies get selected for the exchange and is reasonably price competitive, imagine what it would be equivalent to in marketing dollars for that smaller company. They could never have competed with the behemoths on equal footing in the pre-exchange era.

Also the ACA mandated limit on MLR (Medical loss Ratio) is already crimping the profits and skimming that used to go on in the insurance industry. As the industry improves, regulators can tighten up the ratio from 80/20 to 85/15 improving it even further. What service do the insurance companies provide any way? Their main reason to exist was to deny payments for services before. Now, they can't do that any more. So, they obviously don't need that many "claim adjusters". And the next logical question is what the function of the insurance company even is?!?!

 

[winger]

CBS had a feature on this website that provides easier access to health insurance exchange data. Note that some states that are not on the federal website are not included yet but it looks pretty user friendly to me. The feature indicates that a few young gurus put it together over a weekend.

HealthSherpa

I just tried it. Very cool. Health Care costs may help us decide where to live in the future. You can choose by zip code.