Join Early Retirement Today
Closed Thread
 
Thread Tools Search this Thread Display Modes
CoveredCA Update, more or less--and doctors disappearing from network in 2013
Old 10-30-2013, 06:54 PM   #461
Full time employment: Posting here.
Accidental Retiree's Avatar
 
Join Date: Feb 2012
Posts: 975
CoveredCA Update, more or less--and doctors disappearing from network in 2013

Well, the other day I logged in and things looked like they were moving along with my California exchange app--except for the fact that somehow 'they' had reversed the month and day of birthdate for DH and me.

Still, it seemed there was progress.

Then I checked again, yesterday, to "manage verification," and saw that I had a link where I was supposed to upload income information.

I tried that link and got an error message.

I also looked at the plans and saw that the price I was initially given, after anticipated tax credits, had gone from $49 to $75, for the same bronze HSA
plan.

Today there's a step back, and not even the upload link appears. I won't even look at anything else.

I guess Covered CA is still practicing.

And in other insurance news, from my EOB I learned that the 'free' mammogram I had a couple of weeks ago is going to cost me $300+. I've had the same provider and the same plan since January 2011; however, somehow or other, my mammogram provider has dropped out of the network, with no notification to me.

Ditto for my gynecologist, so the doctor I have used for, oh, 10 years or so, as recently as 2012 at no charge for an annual well woman visit, now no longer will provide that under the insurance I've had since 2011. Again, no notification that she is no longer in my network.

So I cancelled my upcoming visit, explaining why, and guess I will look for another doctor, uhm, when the CoveredCA program gets its in-network doctors posted?

Or, I can just bite the bullet and pay out of pocket for my long-term ObGyn.
Yeah, that's what I'll do.

I hope this mess gets sorted out soon.

I am very, very grateful to have had the coverage I had for the many years I had it, and I guess I will look at these new challenges along the lines of what ClifP talked about in another post elsewhere on the forum.
__________________

__________________
Chief Retirement Strategist
The AR Group
Accidental Retiree is offline  
Join the #1 Early Retirement and Financial Independence Forum Today - It's Totally Free!

Are you planning to be financially independent as early as possible so you can live life on your own terms? Discuss successful investing strategies, asset allocation models, tax strategies and other related topics in our online forum community. Our members range from young folks just starting their journey to financial independence, military retirees and even multimillionaires. No matter where you fit in you'll find that Early-Retirement.org is a great community to join. Best of all it's totally FREE!

You are currently viewing our boards as a guest so you have limited access to our community. Please take the time to register and you will gain a lot of great new features including; the ability to participate in discussions, network with our members, see fewer ads, upload photographs, create a retirement blog, send private messages and so much, much more!

Network/doctor choices in exchanges
Old 10-30-2013, 07:16 PM   #462
Recycles dryer sheets
 
Join Date: Oct 2013
Location: SF Bay Area
Posts: 85
Network/doctor choices in exchanges

This year and probably the next year is going to be a bit rough as all the insurance companies don't have massive (any) amount of data to find out what they will get out of playing in the exchange.

They are either low balling to maximize sign-ups (BC), or bidding high to keep the unwashed masses out (Kaiser, california), or somewhere in between. They are all over the map as they don't even know what their strategy should be.

Their usual plan to confuse and obfuscate has been called out and the market has been flattened out because of the standardization of benefits. The only saving grace for them is that the sand box is still small -- individual market covering only 5% of the total market.

I see the small companies dumping people into the exchange a positive development in making this experiment reach market pricing very quickly as it introduces more people into the pool and also the companies act like bulk buyers with a lot of clout.

One major mechanism through which the market forces act is the doctor choice -- the other being of course the cost. The high price, non-cost effective doctors are going to be ostracized from PPO exchange plans as they don't make sense. They will probably be picked up by HMO plans if they are really good -- but they may have to settle for a Benz instead of a Bentley.

There is certainly going to be a lot of price pressure on the insurers and they cannot afford to take the exchanges lightly in the coming years. The costs *are* going to come down as people flock to the lower cost insurance companies. But it is going to take a couple of years.

When you are cleaning house, there is going to be a little bit of mess and dust. But that's no reason not to.
__________________

__________________
47 is offline  
Old 10-30-2013, 07:52 PM   #463
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
clifp's Avatar
 
Join Date: Oct 2006
Posts: 7,450
Quote:
Originally Posted by 47Percent View Post
This year and probably the next year is going to be a bit rough as all the insurance companies don't have massive (any) amount of data to find out what they will get out of playing in the exchange.

...
One major mechanism through which the market forces act is the doctor choice -- the other being of course the cost. The high price, non-cost effective doctors are going to be ostracized from PPO exchange plans as they don't make sense. They will probably be picked up by HMO plans if they are really good -- but they may have to settle for a Benz instead of a Bentley.

There is certainly going to be a lot of price pressure on the insurers and they cannot afford to take the exchanges lightly in the coming years. The costs *are* going to come down as people flock to the lower cost insurance companies. But it is going to take a couple of years.

When you are cleaning house, there is going to be a little bit of mess and dust. But that's no reason not to.

While there was a lot I opposed about ACA both on practical and philosophical grounds one of the things I was genuinely excited about was the comparison aspect of the exchanges.

I don't know who was the smart guy that forced financial institutions to publish an APR when they talked about their products, but that guy/gal deserves a medal.

Health case is more complicated, but I am happy they made a stab and simplifying it with the metals designations. There are two other aspects which are very important (although not in Hawaii) the network of providers and the quality of the insurance coverage.

Evidently in most states the insurance companies that didn't score well have pushed the exchanges not to publish the quality rates.

I am curious if anybody who has signed up was aware or used the quality rate system?
__________________
clifp is offline  
Old 10-30-2013, 08:52 PM   #464
Thinks s/he gets paid by the post
Free To Canoe's Avatar
 
Join Date: May 2008
Location: Cooksburg,PA
Posts: 1,738
I was not aware of the quality ratings. I think they will help me decide on an insurer.

The rankings are published here:
NCQA > HPR 2013-2014
__________________
Free to canoe
Free To Canoe is offline  
Old 10-31-2013, 05:37 AM   #465
Moderator
MichaelB's Avatar
 
Join Date: Jan 2008
Location: Rocky Inlets
Posts: 24,455
Quote:
Originally Posted by Free To Canoe View Post
I was not aware of the quality ratings. I think they will help me decide on an insurer.

The rankings are published here:
NCQA > HPR 2013-2014
Nice link. I added it to the FAQ.
__________________
MichaelB is offline  
Old 10-31-2013, 11:12 AM   #466
Thinks s/he gets paid by the post
Free To Canoe's Avatar
 
Join Date: May 2008
Location: Cooksburg,PA
Posts: 1,738
Quote:
Originally Posted by MichaelB View Post
Nice link. I added it to the FAQ.
Thanks for all of your work on the FAQ. What a great resource! Don't know how I missed it so far.
__________________
Free to canoe
Free To Canoe is offline  
Old 10-31-2013, 11:45 AM   #467
Thinks s/he gets paid by the post
sengsational's Avatar
 
Join Date: Oct 2010
Posts: 3,837
Quote:
Originally Posted by 47Percent View Post
On the flip side, if you are eligible for subsidy and if you are in your 50's (most of us ER's are), it is quite likely that the kids policy is given gratis.

Yes, it costs you ZERO additional dollars as your expenditure is capped at fixed percentage around 9%. If you are already at that level, which is what subsidy-eligible means, adding a person to the policy doesn't cost any thing more. The subsidy just expands to accommodate the increased cost!
That's a slam-dunk for kids that are going to be claimed on the parents' taxes as a dependent, the kid doesn't make any significant money, and is considered in the one "household". But there are some mysterious rules that apply to kids less than 26 that do make money enough to need to file taxes. In this case, the kid would be a hosehold of one, and just the couple would be anothe household. I wish I knew how they determine when the household gets split.

These two FAQ items don't really conflict, but there's a gap:

Quote:
My wife and I want to cover our 25-year-old son as a dependent on our policy. We have no other children. We don’t claim him as a dependent, he doesn’t live with us, and he has a job. We also have modest income and hope we can qualify for premium tax credits in the Marketplace. Do we have to count our son as a member of our household when we apply? Do we have to count his income when we apply?

No. You and your husband will be counted as a household of two and the income you and he report on your joint tax return will be counted for purposes of determining your eligibility. Your son will be counted separately as a household of one, and his income will be counted separately to determine his eligibility. After the Marketplace decides the amount of premium tax credit each of your “households” are eligible for, the three of you can apply for a family policy offered on the Marketplace and you can apply your combined premium tax credits to reduce what your family has to pay for that policy.



Quote:
Do my parents have to claim me as a tax dependent for me to be on their health plan to age 26?

No. You do not need to be a tax dependent of your parents to continue to be covered as a dependent on their health plan.
__________________
sengsational is offline  
Old 10-31-2013, 07:26 PM   #468
Thinks s/he gets paid by the post
 
Join Date: Feb 2011
Posts: 1,629
Quote:
Originally Posted by Free To Canoe View Post
I was not aware of the quality ratings. I think they will help me decide on an insurer.

The rankings are published here:
NCQA > HPR 2013-2014
Good link, but depressing. The best HI plan in my area appear to be 400+ in the ratings
__________________
ERhoosier is offline  
Old 10-31-2013, 07:50 PM   #469
Recycles dryer sheets
 
Join Date: Oct 2013
Location: SF Bay Area
Posts: 85
Quote:
Originally Posted by sengsational View Post
That's a slam-dunk for kids that are going to be claimed on the parents' taxes as a dependent, the kid doesn't make any significant money, and is considered in the one "household". But there are some mysterious rules that apply to kids less than 26 that do make money enough to need to file taxes. In this case, the kid would be a household of one, and just the couple would be anothe household. I wish I knew how they determine when the household gets split.
If the kid is a minor, no splitting whatsoever. After that I believe it just has to do with the age of the kid, and most likely the same rules as the kiddie tax rules.
__________________
47 is offline  
Old 10-31-2013, 10:48 PM   #470
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
pb4uski's Avatar
 
Join Date: Nov 2010
Location: Vermont & Sarasota, FL
Posts: 16,428
The governor of Vermont announced today that because the sign up system is so screwed up that they will allow current plans to continue on to March 31, 2014 rather than December 31, 2013. See Shumlin extends deadline for health care exchange

Since my current plan is over $100/month less than the similar 2014 plan, I think I've just saved $300+.

I suspect it is probably just a matter of time before the Obama administration crys uncle and does something similar.
__________________
If something cannot endure laughter.... it cannot endure.
Patience is the art of concealing your impatience.
Slow and steady wins the race.
pb4uski is online now  
Old 10-31-2013, 11:55 PM   #471
Recycles dryer sheets
 
Join Date: Jan 2005
Posts: 486
Quote:
Originally Posted by pb4uski View Post
I suspect it is probably just a matter of time before the Obama administration crys uncle and does something similar.
I think so, too. Some of the smaller exchange insurers were saying that they are not even coming close to enrolling their break-even number to support the cost of the plans and will be forced to raise the rates of the plans - which would really throw things into a death spiral.
__________________
tinlizzy is offline  
Old 11-01-2013, 10:56 AM   #472
Full time employment: Posting here.
 
Join Date: May 2011
Location: Marco island
Posts: 813
According to CBS, there were 6 people enrolled on day one.
__________________
Gatordoc50 is offline  
Old 11-01-2013, 10:59 AM   #473
Moderator
ziggy29's Avatar
 
Join Date: Oct 2005
Location: Texas
Posts: 15,612
Quote:
Originally Posted by tinlizzy View Post
I think so, too. Some of the smaller exchange insurers were saying that they are not even coming close to enrolling their break-even number to support the cost of the plans and will be forced to raise the rates of the plans - which would really throw things into a death spiral.
It remains to be seen, though, if this is primarily because the glitches are preventing a lot of enrollments. If that's the case, this should eventually resolve itself. If not......
__________________
"Hey, for every ten dollars, that's another hour that I have to be in the work place. That's an hour of my life. And my life is a very finite thing. I have only 'x' number of hours left before I'm dead. So how do I want to use these hours of my life? Do I want to use them just spending it on more crap and more stuff, or do I want to start getting a handle on it and using my life more intelligently?" -- Joe Dominguez (1938 - 1997)

RIP to Reemy, my avatar dog (2003 - 9/16/2017)
ziggy29 is offline  
Old 11-01-2013, 11:07 AM   #474
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
 
Join Date: Apr 2013
Posts: 5,580
Yep, 50% of the insurers in this meto area don't have their ACA networks defined yet. Pretty tough for anyone to judge how this is going, regardless of website issues.

MRG
__________________
MRG is offline  
Old 11-01-2013, 11:42 AM   #475
Thinks s/he gets paid by the post
sengsational's Avatar
 
Join Date: Oct 2010
Posts: 3,837
Quote:
Originally Posted by Free To Canoe View Post
I was not aware of the quality ratings. I think they will help me decide on an insurer.

The rankings are published here:
NCQA > HPR 2013-2014
Thanks for that link. We have only two companies on the exchange in my county of NC: BCBS and Coventry. Coventry is rated lower, in general, and isn't much less expensive, so I guess I knw who I'll be buying from.
__________________
sengsational is offline  
Old 11-01-2013, 11:43 AM   #476
Moderator
ziggy29's Avatar
 
Join Date: Oct 2005
Location: Texas
Posts: 15,612
Quote:
Originally Posted by sengsational View Post
Thanks for that link. We have only two companies on the exchange in my county of NC: BCBS and Coventry. Coventry is rated lower, in general, and isn't much less expensive, so I guess I knw who I'll be buying from.
Right now in Texas, BCBS is the *only* insurer showing up on the Exchange. There are 17 plans, so you have plenty of choice as long you choose BCBS...

At least they are a known entity and most doctors accept it.
__________________
"Hey, for every ten dollars, that's another hour that I have to be in the work place. That's an hour of my life. And my life is a very finite thing. I have only 'x' number of hours left before I'm dead. So how do I want to use these hours of my life? Do I want to use them just spending it on more crap and more stuff, or do I want to start getting a handle on it and using my life more intelligently?" -- Joe Dominguez (1938 - 1997)

RIP to Reemy, my avatar dog (2003 - 9/16/2017)
ziggy29 is offline  
Old 11-01-2013, 12:25 PM   #477
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
audreyh1's Avatar
 
Join Date: Jan 2006
Location: Rio Grande Valley
Posts: 16,471
Quote:
Originally Posted by ziggy29 View Post
Right now in Texas, BCBS is the *only* insurer showing up on the Exchange. There are 17 plans, so you have plenty of choice as long you choose BCBS...

At least they are a known entity and most doctors accept it.
It depends on your county. Humana shows up as an exchange option in my county. And when I looked off exchange a couple more showed up.

Here is a list of Texas insurers on the Exchange. Some serve very limited areas:
TEXAS MARKETPLACE INFORMATION
__________________
Well, I thought I was retired. But it seems that now I'm working as a travel agent instead!
audreyh1 is offline  
Old 11-01-2013, 12:32 PM   #478
Recycles dryer sheets
winger's Avatar
 
Join Date: Jan 2007
Posts: 251
I went through the sign-up for the ACA this morning. Absolutely no issues, waiting for verification now. I had created login before 10/1, but it seems to be gone. I used new username, password, and email address.

We are Megacorp retirees, and have had a BCBS "Cadillac" plan since 2005. By Cadillac, I mean no deductible. Still have co-pays and 90% payment on some things. Megacorp has offered the same plan for 2014. Price is up, as it has every year. First year was $9 a month, 2014 will be $372 a month.

Any way, we like our insurance. And we are going to keep it. It never hurts to look at the options, though.
__________________
winger is online now  
Old 11-01-2013, 02:30 PM   #479
Thinks s/he gets paid by the post
 
Join Date: Dec 2007
Posts: 4,764
Still waiting to be verified since October 4th. My last conversation with the arc rep was " Sir you have done everything you can but unfortunately it is on our end and we have no time table when this will be fixed." This is my first application. I haven't tried the whole make a new login and reapply deal. I pulled my free credit report and on October 4th I have 2 pulls one from CMS and the other from Experian or whatever the agency is.

Probably a good thing I don't need coverage the 1st of January.
__________________
Notmuchlonger is offline  
Old 11-01-2013, 02:34 PM   #480
Moderator
ziggy29's Avatar
 
Join Date: Oct 2005
Location: Texas
Posts: 15,612
Quote:
Originally Posted by Notmuchlonger View Post
I pulled my free credit report and on October 4th I have 2 pulls one from CMS and the other from Experian or whatever the agency is.
For what it's worth, I believe these should be "soft pulls" on your credit report and shouldn't have any adverse impact on your credit score.

I think.
__________________

__________________
"Hey, for every ten dollars, that's another hour that I have to be in the work place. That's an hour of my life. And my life is a very finite thing. I have only 'x' number of hours left before I'm dead. So how do I want to use these hours of my life? Do I want to use them just spending it on more crap and more stuff, or do I want to start getting a handle on it and using my life more intelligently?" -- Joe Dominguez (1938 - 1997)

RIP to Reemy, my avatar dog (2003 - 9/16/2017)
ziggy29 is offline  
Closed Thread


Currently Active Users Viewing This Thread: 1 (0 members and 1 guests)
 
Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are Off
Pingbacks are Off
Refbacks are Off


 

 
All times are GMT -6. The time now is 04:55 AM.
 
Powered by vBulletin® Version 3.8.8 Beta 1
Copyright ©2000 - 2017, vBulletin Solutions, Inc.