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Getting dumped by my healthcare provider
Old 06-24-2013, 05:33 PM   #1
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Getting dumped by my healthcare provider

Got a letter today from Aetna that as of 12/31/13 - my family is on it's own....I had a feeling this would happen. Aetna was not part of the California Care program - this makes me sick and nervous.....I've been sending big $ to Aetna for years - over $1100 for the last couple years - starting at $360 7 years ago.
I am being pushed out and not sure where we will end up for sure....I will have some sleepless nights. I like having everything set up and this is a big "what if" for me.
I always feared that HC would be the wildcard in ER - anyone out there have a vicodin? Any words of wisdom - and a vicodin.
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Old 06-24-2013, 05:38 PM   #2
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Have you looked at the Covered Cal website yet? Individual and Family Health Insurance | Covered California?
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Old 06-24-2013, 05:40 PM   #3
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Donzo,

Welcome to a Health Exchange...coming to your neighborhood soon. Starting Jan. 2014....http://www.healthexchange.ca.gov/Pages/Default.aspx

omni
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Old 06-24-2013, 07:37 PM   #4
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Donzo,

Getting dumped by your health care provider will have very different consequences than in the past.

Under PPACA (aka Obamacare) if you are in the individual market, starting in 2014
- insurer's will not be allowed to deny you coverage
- rates will not be allowed to vary based on your medical conditions

- rates will only be allowed to vary based on:
1 Age (max 3:1 ratio)
2 Tobacco use (max 1.5:1 ratio)
3 location (where you live)
4 number of people on your policy

As someone who has come down recently with a rather nasty case of Kidney Stones, I was alarmed to see that this could make me, under the old rules, uninsurable. After 1/1/2014, I should be able to purchase insurance in the individual market without price discrimination for the prior kidney stones episode.

After I realized this I now feel much relief.

-gauss
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Old 06-24-2013, 08:46 PM   #5
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DH and I got the same letters today. We read a couple of weeks ago that Aetna was not going to be part of the Covered California exchange. We will just go the exchange and deal with it. That's all. The premiums are not too different.

We have pumped a lot of premium $$$$ into Aetna for the past few years, with little use of the policies, but that is what insurance is about, right? I'd rather NOT have had to use them than not have paid and then have had need of insurance.

DH has a pre-existing condition, so at least we're covered there, in 2014.
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Old 06-25-2013, 09:21 AM   #6
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Thanks for the replies and links. I guess I should not be concerned as long as this program rolls out as expected! Almost seems to good to be true . This may be a better situation all around - will be interesting to see if the cost will have the same yearly jump as it has since 06 or be more stable.

Yes AccRet insurance is just that - pumping money in for years will get you nothing unless you have a claim (and piece of mind). I still hate to see them get off so easy

Good info gaus, thanks - sorry to hear of your stones.

I read the links carefully thanks MB and Omni!
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Old 06-25-2013, 09:39 AM   #7
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Donzo-
You should be fine in CA with their Exchange in place with solid info on your '14 HI options. With only ~3mo left before scheduled open enrollment under ACA, in most states their Exchanges (whether Federal or fed/state partnerships) remain unfinalized with no exact details of insurers participating, plan features (beyond basic 'metal' descriptions), premiums, etc.
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Old 06-25-2013, 09:43 AM   #8
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Quote:
Originally Posted by gauss
Donzo,

Getting dumped by your health care provider will have very different consequences than in the past.

Under PPACA (aka Obamacare) if you are in the individual market, starting in 2014
- insurer's will not be allowed to deny you coverage
- rates will not be allowed to vary based on your medical conditions

- rates will only be allowed to vary based on:
1 Age (max 3:1 ratio)
2 Tobacco use (max 1.5:1 ratio)
3 location (where you live)
4 number of people on your policy

As someone who has come down recently with a rather nasty case of Kidney Stones, I was alarmed to see that this could make me, under the old rules, uninsurable. After 1/1/2014, I should be able to purchase insurance in the individual market without price discrimination for the prior kidney stones episode.

After I realized this I now feel much relief.

-gauss
Maybe the insurance companies are dumping those with chronic Illnesses now so they aren't locked into them after 2014. Without underwriting, premiums would have to be increased for everyone making it difficult to compete with the exchanges. Eventually, insurance costs should be identical whether inside or outside the exchanges. The only difference will be who offers the greatest subsidy. Your boss or Uncle Sam.
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Old 06-25-2013, 09:47 AM   #9
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Never miss an opportunity to get in a dig.

Actually, the California exchange and FFE's may be at the same stage of development and policy offering for all we know. The Cal policies are still under negotiation, as are the FFE offerings, but one has chosen to share more details with the general public. More details shared does not mean more progress.

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Originally Posted by Gatordoc50 View Post
Maybe the insurance companies are dumping those with chronic Illnesses now so they aren't locked into them after 2014. Without underwriting, premiums would have to be increased for everyone making it difficult to compete with the exchanges. Eventually, insurance costs should be identical whether inside or outside the exchanges. The only difference will be who offers the greatest subsidy. Your boss or Uncle Sam.
Can't do that. Insurers can withdraw policy offerings from entire groups but not dump specific individuals because of medical condition.
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Old 06-25-2013, 09:56 AM   #10
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Originally Posted by MichaelB
Never miss an opportunity to get in a dig.

Actually, the California exchange and FFE's may be at the same stage of development and policy offering for all we know. The Cal policies are still under negotiation, as are the FFE offerings, but one has chosen to share more details with the general public. More details shared does not mean more progress.

Can't do that. Insurers can withdraw policy offerings from entire groups but not dump specific individuals because of medical condition.
Oh, I thought that individuals were being let go on this forum. The whole group is being dumped. That does make more sense. Still wonder why they are getting out, though.
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Old 06-25-2013, 10:16 AM   #11
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From the LA Times Aetna to exit a key market in California - Los Angeles Times

Quote:
Facing tougher price competition from a state-run marketplace, Aetna Inc. said it would exit California's individual health insurance market by year-end and leave nearly 50,000 customers searching for new coverage.

Aetna, the nation's third-largest health insurer, will maintain a major presence in California with a focus on large and small employers. But the move reflects how the federal healthcare law and its rollout in different states is rapidly reshaping the health insurance landscape for millions of consumers.

./.

"National companies that don't have a strong local presence may not be able to compete on price very well if they don't have the best networks or best discounts," said Gary Claxton, a vice president at the Kaiser Family Foundation, a nonpartisan research group. "Aetna has places where it is stronger."
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Old 06-25-2013, 10:37 AM   #12
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Originally Posted by MichaelB
Thanks for the link.
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Old 06-25-2013, 10:58 AM   #13
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After doing some reading on large employer obligations, it seems that they will incur fines if employees opt for the exchange and get subsidized. In essence, large employees will have to offer insurance at lower cost to the employee than the exchanges, subsidies included. Is that correct?
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Old 06-25-2013, 11:18 AM   #14
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Originally Posted by Gatordoc50 View Post
After doing some reading on large employer obligations, it seems that they will incur fines if employees opt for the exchange and get subsidized. In essence, large employees will have to offer insurance at lower cost to the employee than the exchanges, subsidies included. Is that correct?
That is true, but larger companies that don't currently heavily subsidize their insurance coverage may choose not to do so in the future under the ACA. The penalties are $3000 per employee that chooses to use the exchange and get a subsidy. So a large corporation may contemplate the law and decide to efficiently breach the requirement to insure all employees. After all, it may cost them $10000-15000 per employee to offer reasonably affordable (compared to the exchanges) insurance to those employees with families. Some companies may view $3000 as quite Affordable and inform their employees that the exchanges exist and subsidies are available. I imagine most large companies are doing the math (or already have done the math) and will decide what course of action to take in their upcoming benefits offerings.
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Old 06-25-2013, 12:24 PM   #15
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Must have been interrupted when I was typing as my post did not get posted...


I find in interesting that people think that past insurance payments means a locked in policy for life... why

I have lost insurance a number of times... twice due to companies deciding to get out of a market... they moved on.... I moved on.... it is a business decision....

So, you contract for a year for insurance... at the end of the year you can decide to go with another company.... they can also... (now, there are laws etc that would not allow this for various reasons... but normally)...

it is not like they are kicking you out because they have to pay big bills... so why do past premiums come into play
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Old 06-25-2013, 01:08 PM   #16
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Originally Posted by MichaelB View Post

Actually, the California exchange and FFE's may be at the same stage of development and policy offering for all we know. The Cal policies are still under negotiation, as are the FFE offerings, but one has chosen to share more details with the general public. More details shared does not mean more progress.
Not sure I agree. CA, and a few other states, have published which firms have been accepted to offer HI thru Exchange along with (at least prelim) rates. For some of us, we do not even know which companies will participate in Exchange- let alone any rate info. To me this all suggests CA is MUCH closer to an operational Exchange. Being close to FIRE with no pension nor retiree HI, this is more than an academic difference to me.

Re- employer subsidies: This has traditionally been part of benefit package to attract the best talent. Unfortunately many employers have been cutting their HI subsidy over past few yrs so folks are paying a higher proportion of the total premium. For some who are now paying 50+% of their premiums, HI becomes less of a reason to stick around
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Old 06-25-2013, 05:18 PM   #17
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I find in interesting that people think that past insurance payments means a locked in policy for life... why
Maybe they have been sold universal/whole life policies in the past (as opposed to term life insurance which would be a better analogy) where the model was to pay more in the early years for the right to pay less in the later years.

-gauss
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Old 06-26-2013, 11:16 AM   #18
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Aetna dropping out of the California individual health market is very interesting. I was an Aetna individual health insurance customer from the time I FIREd in 2007 until October, 2012.

From my personal experience, they offered teaser rates and then their rates inflated rapidly for existing subscribers. Maybe this was a bid to get into the market with a significant market share. I am in my 40s, and my personal experience was an annual premium increase rate of about 22% per annum over that 5.4 year time frame.

Anyway, this makes me glad that I got out last year as I live overseas and the only real reason for me to stay was because my grandfathered plan might be better than other options. But that turned out not to be the case, I would have been dropped anyway. I have always believed that the PPACA will lead to a quick end to most grandfathered plans and that was one of my incentives for leaving the system. I no longer maintain USA health insurance and just buy temporary USA insurance for my USA visits.
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Covered California rates not that good at all...
Old 07-08-2013, 07:01 PM   #19
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Covered California rates not that good at all...

I also am an early retiree and recently received the same letter from Aetna. But for my situation, the Covered California exchange is not offering me any bargains. I am just over the limit to qualify for federal subsidies, so my insurance premium under Covered California will increase nearly $325 a month! And I have no preconditions, and take no medicines whatsoever! So much for Obama's promise that "... The insurance policy you have today, you will still have tomorrow". The politicians obviously live in a different world.
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Old 07-08-2013, 07:17 PM   #20
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I also am an early retiree and recently received the same letter from Aetna. But for my situation, the Covered California exchange is not offering me any bargains. I am just over the limit to qualify for federal subsidies, so my insurance premium under Covered California will increase nearly $325 a month! And I have no preconditions, and take no medicines whatsoever! So much for Obama's promise that "... The insurance policy you have today, you will still have tomorrow". The politicians obviously live in a different world.
Welcome to the "War on the Bros", as I am a proud member also. Google the term if you are curious. Take some solace in the fact that when we start to push 60, the 3-1 premium ratio over young people will eventually work back in our favor and mitigate some of the losses before Medicare. Provided of course that doesn't change!
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