Applying for ACA 2017 Coverage

[NW-Bound]

There are NO individual plans outside of the exchange for 2017, where I live.

And there is only ONE insurer on the exchange, offering a total of 1 Bronze, 2 Silver, and 1 Gold plans. That's it.

As I have said repeatedly, it kills me to know why we here in AZ are so different than people elsewhere.

 

[NW-Bound]

Back on the process of getting coverage for 2017, I have not bothered to register yet, seeing that there's no choice to be made. I will wait till December.

Might want to check the provider list again today. HealthNet added 5 hospitals and about 220 Dr's within a 20 mile radius of my Az home since yesterday!

I have checked in to the exchange a few times to see if they have added my existing PCP, but no luck so far. He does not show up on any of the above 4 plans. I checked the roster for 2016, and he was there.

So, I do not know if they exclude him or he does not want to play. If I get a chance, I will ask him. He's not the greatest doctor, but it is a pain to go to another one, when we have had him for many many years.

 

[ShokWaveRider]

I have checked in to the exchange a few times to see if they have added my existing PCP, but no luck so far. He does not show up on any of the above 4 plans. I checked the roster for 2016, and he was there.

So, I do not know if they exclude him or he does not want to play. If I get a chance, I will ask him. He's not the greatest doctor, but it is a pain to go to another one, when we have had him for many many years.

I can empathize with you here. My doctor also was not on the available plans this year. So I had to register with another doctor 1 mile away. I have a meet and greet appointment in January. So not so bad, and with EMRs no real issue.

I too was concerned. I called the billing dept of my original doctor and they said they had applied to the insurance company I was getting for 2017 several times in 2015, and 2016 and for 2017. The insurance refused to reply to them. This is disgusting.

 

[NW-Bound]

I have not bothered to check to see what hospitals are in their network. Having no choice, whatever it is I have to accept it. No point in agonizing over it, unless I want to relocate to another state. Not having a choice makes your life simpler, doesn't it? I'd rather spend the time thinking about what stocks to buy or sell. That, I have control over.

We use but only about $300-400 worth of healthcare services in 2016. Hopefully, that will stay the same in 2017, and we will not have to find out if the hospitals in their network are good or bad. Until then, ignorance is bliss.

 

[ivinsfan]

Save some blame for state insurance regulators who, in some states, approved rate increases higher than insurance companies requested:



Regulators approve higher health premiums to strengthen Obamacare insurers

In MN I'l baldly state the increase was a bribe in disguise aimed at keeping insurers from exiting the market, this came along in addition to very tight caps. so some like Medica who already have almost 45K customers agreed to go the 50K and a bigger raise then they needed for the existing 45K. Creative minds at work.

 

[GTFan]

And now Anthem (parent of BCBS) is threatening to leave after 2017 if things don't improve. This on top of massive price increases and their newfound ACA monopoly in many states.

If this doesn't smell like a 'we've got you by the balls' play now, I don't know what is.

Anthem Threatens Obamacare Retreat If Results Don’t Improve - Bloomberg

 

[MRG]

Used a broker this year. Can't really compare to last year as we are in a different state, with their own exchange.

Choices are down, prices and subsidies up. At least I can buy insurance.

 

[NW-Bound]

...Choices are down, prices and subsidies up. At least I can buy insurance.

But can we get into any decent hospital if we need it?

 

[MichaelB]

But can we get into any decent hospital if we need it?

Exactly. That's the choice that matters.

 

[MRG]

But can we get into any decent hospital if we need it?

Yes. At least in this part of the state.

 

[NW-Bound]

If this is not the impetus for Americans to take better care of themselves (to avoid hospitals), I don't know what is.

On another thread, we talk about the ability to order our own blood tests. Heck, the next step is to order our own MRI/CT Scan, then we are all set to head overseas for treatment, armed with the self-diagnosis info.

 

[Walt34]

... especially since I'm still only 51. The thought of dealing with the dysfunctional individual insurance market until we're on Medicare is very unappetizing.

Who's to say that when you get to 65, Medicare will be as it is now?

Nothing of course, and there probably will be some changes but those are unknowable so one plans the best one can.

The price increases I'm seeing on this thread are downright scary. We're fortunate that my former employer heavily subsidizes our health insurance and although they say they fully intend to keep that for retirees, they will not promise it. With cost increases I'm seeing here I can see why. I'm on Medicare but it'll be five years before DW is. Given the prices I'm seeing here if the former employer drops retiree HI we will be doing some serious belt-tightening.

 

[NW-Bound]

Think about this. For a 60-year old individual like myself, the premium is $1K/month and the deductible is $6.8K/year. How much would it be if a 70-year old or an 80-year old had to buy his/her own insurance? Remember that the insurer has to pay out 85% of the premium.

Of course, the government pays most of the tab for the older folks. But for how long?

 

[NW-Bound]

OK, I have the answer. In 2015, the total Medicare cost is $632 billion for 57 million people above 65.

That works out to $11K for each geezer. I am surprised that it is not that high compared to ACA cost for a 60. Darn, these youngsters are a bunch of sickos.

PS. The total cost per individual is much higher, as both geezers and youngsters have out-of-pocket costs.

 

[MichaelB]

That works out to $11K for each geezer. I am surprised that it is not that high compared to ACA cost for a 60. Darn, these youngsters are a bunch of sickos.

That's one possibility. What is unusual, however, is that they are needing large amounts of medical care all around the country, and after 3 years, don't seem to be getting better. So, perhaps this is a small group of individuals with serious chronic care needs.

Another possibility is that some of the costs insurers are incurring for their Medicare / Medicaid / group coverage are being allocated to individual policies.

 

[Packman]

NW - Bound, I am told there are two policies now being offered in Maricopa county, AZ outside the ACA. I got the links below from an insurance broker. One is from Cigna and one from Aetna. The network on the Cigna plan was so lousy it only brought up 3 PCP's within 20 miles of my home. The Aetna plan was a silver plan that looked good to me, but the premiums were about the same as the ACA silver plan from Health Net ($24k/year for two of us).

Arizona Health Insurance and Coverage Options | Cigna

https://www.aetna.com/plan-info/individual/health-plans/2017/arizona.html

As for me, I will take an ACA plan and keep my income below the subsidy max.

(Sorry, I'm not sure if I pasted the links correctly as links)

 

[NW-Bound]

Thanks for the info. eHealthInsurance still shows nothing off the exchange for my Zip code.

I looked at the links that you gave. For people who are curious, here's the result.

1) Cigna Bronze PPO: $19K annual premium for 2, $12.8K deductible
2) Cigna Bronze HMO: $17.2K premium for 2, $12K deductible
3) Aetna Silver HMO: $23.4K annual premium for 2, $12.2K deductible

None has my current PCP. I could not find out what hospitals are in Cigna's network. Aetna seems to have only Banner hospitals.

For comparison, I was thinking about a Bronze Plan on the exchange.

Ambetter Bronze HMO: $22.7K annual premium, $13.6K deductible.

The on-exchange deal looks more expensive (the clientele is sicker?). On the other hand, Ambetter shows many hospitals, at least one looks OK to me.

Same as you I look at the subsidy. For joint income up to the 400% FPL of $64K, the subsidy is $1,628/month or $19.5K/year. This high subsidy is too hard to pass up, particularly as we need so little healthcare ($300-400 worth) and see no reason to choose an off-exchange plan to offset that huge subsidy.

Health insurance for us is just financial protection against some catastrophic circumstances, and paying near $20K for it is just too much (we would have to incur around $35K worth to even get anything). So, I need to get meself some subsidy. Enjoy it while it lasts, I guess.

It is interesting that my PCP is not on any plan. Did he do something bad to be kicked out, or he got pissed off at individual health plans and refused to take any patient outside of group insurance?

 

[GTFan]

What if you go with a 364-day, non-ACA compliant short-term plan? Any of those in your market? Yeah you might have to pay the fine but there are ways around that. Also might need to talk to a local broker to find them.

http://khn.org/news/102913-michelle-andrews-364-day-insurance-plans/

 

[athena53]

I see I'm a victim of the BCBS switch here in MO. I had them this year, having ditched Coventry last year when all they offered for 2016 was coverage with zero out-of-network. I am a sparse user (thank God) of medical services but for me that was a dealbreaker. So I got a BCBS policy for 2016 and now they're puling the same crap for 2017. I don't know if they called it an HMO, but that's my definition- all your care is in the network or it's on your dime.

Healthcare.gov worked quite well for me this morning. I have 25 (!) plans available and drilled down on one Cigna plan and it does offer decent out-of-network coverage so I feel a little better. I sent an e-mail to my agent and asked if there's a way he can get the commission if I sign up through healthcare.gov.

 

[MBSC]

What if you go with a 364-day, non-ACA compliant short-term plan? Any of those in your market? Yeah you might have to pay the fine but there are ways around that. Also might need to talk to a local broker to find them.

Short-Term Plans Can Skirt Health Law Requirements | Kaiser Health News

For those who may not know, I just wanted to point out Short-Term Medical (STM) plans exclude pre-existing conditions.

HHS is implementing a rule change effective 4/1/2017 impacting STM plans. Plans issued on or after that date can last no longer than 90 days. There will be a transition period between 1/1/17-3/31/17. STM plans issued during this time can last longer than 90 days but must terminate on or before 12/31/17.

More info: Short-Term Health Plans Cut to Under Three Months in New Rule | Bloomberg BNA

 

[GTFan]

I have mixed feelings about that - as the article states it could make the exchanges more viable because healthy folks will be pushed into it for full-year coverage.

But you're also taking away options for cheaper insurance, which means more folks won't be able to afford coverage if they can't get subsidies.

 

[GTFan]

I see I'm a victim of the BCBS switch here in MO. I had them this year, having ditched Coventry last year when all they offered for 2016 was coverage with zero out-of-network. I am a sparse user (thank God) of medical services but for me that was a dealbreaker. So I got a BCBS policy for 2016 and now they're puling the same crap for 2017. I don't know if they called it an HMO, but that's my definition- all your care is in the network or it's on your dime.

Same here - we went from 2 PPO options this year to none in 2017. And only BCBS and Kaiser as HMO options with zero OON coverage.

But at this point with the way things are going we are lucky to still have two choices.

 

[BrianB]

We are applying through the MNsure exchange in Minnesota. Looking for a silver cost-sharing plan, hoping to get a plan with nearby clinics. Ages 57 & 58. Our income estimate is $33k (just over the minimum for exchange policies in MN). I was hoping to do some Roth conversions during these lower income post-fire years. This is what we have found:

The silver plan we liked best was actually the lowest priced one at $1417 per month. We would qualify for a $1245 per month tax credit, so out of pocket premium will be $172 per month. The net premium will actually drop by $70 per month from our current $242. This plan has a better $2250 + $2250 deductible (we now have $6750 + $6750). We qualified for "73% level" cost sharing reduction. After a 30 minute wait on the phone to get a typo corrected, we got signed up and everything is confirmed.

The only negatives in our view are that this is an HMO plan (no HSA contribution allowed), and the network of clinics is smaller than our current one (no nationwide network if we are travelling).

The Roth conversion doesn't work out so well. Based on a small $6000 conversion we would owe $600 (10%) Federal income tax plus $321 (5.35%) MN state income tax. The additional income would reduce our annual premium tax credit by $924 (15.4%). Total "cost" to convert the $6000 would be $1845 or 30.75%. It looks like we will have to wait on the conversions - maybe the rules will be modified by 2018.

 

[GTFan]

Yep, you have to watch Roth conversions very closely when trying to get subsidies. It's a get money now vs. later calculation.

 

[wmc1000]

Applied on Nov 1st and uploaded the asked for income documentation including a letter laying out why I thought my income would be lower than this year.

Got a call this morning from a marketplace gal who said my income documentation was higher than the income I put in for next year. I agreed with that and then asked her if she had my uploaded letter explaining why next year would be lower. After searching her electronic files for a minute she found the letter of explanation. She said she would send it back to be reviewed again and I would hear from them after the re-review.

We shall see what happens now. At least they are looking at the uploaded info in a timely manner!