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Old 11-09-2012, 07:13 AM   #21
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i live in mass. we already have this. Unless your poor enough to qualify for subsidies even though you are guaranteed coverage it is not cheap.


example for 60 year old singles. 570 a month premium 2400 deductible.

there are some options lower but you have to go to certain clinics.

best way to see what i mean.

google/bing massachusettes health connector. select prompts to price a health plan without subsidies. it does not asky you who you are but will ask d.o.b
and zip code .use a zip code from different parts of mass(look up zips on web)

the connector will list all different types of plans bronze/silver/gold with and without drug. big range premiums/copays no total plan is cheap be forwarned
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Old 11-09-2012, 07:36 AM   #22
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Virginia will defer to a federally-run exchange.

Link to Washington Post article here.
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Old 11-09-2012, 09:08 AM   #23
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i live in mass. we already have this. Unless your poor enough to qualify for subsidies even though you are guaranteed coverage it is not cheap.


example for 60 year old singles. 570 a month premium 2400 deductible.

there are some options lower but you have to go to certain clinics.

best way to see what i mean.

google/bing massachusettes health connector. select prompts to price a health plan without subsidies. it does not asky you who you are but will ask d.o.b
and zip code .use a zip code from different parts of mass(look up zips on web)

the connector will list all different types of plans bronze/silver/gold with and without drug. big range premiums/copays no total plan is cheap be forwarned
OK, I looked. I'm not familiar with the details in MA, but they seem reasonable to me ( better than being denied coverage ), $360 for a bronze plan. Didn't see any high deductible plans. Seems to be a wide range in price for basically the same coverage, $346 - $551, different companies.

I do plan on being "poor" enough for subsidies, unless they start means testing
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Old 11-11-2012, 07:23 PM   #24
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I keep reading about how difficult it will be for states to start HI exchanges by Oct '13 and think I must be missing something. Isn't what a company like "ehealthinsurance" does essentially a form of web-based HI exchange? Why couldn't a state just use such a web-based model for "qualified" plans for their state residents?
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Old 11-11-2012, 07:49 PM   #25
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I keep reading about how difficult it will be for states to start HI exchanges by Oct '13 and think I must be missing something. Isn't what a company like "ehealthinsurance" does essentially a form of web-based HI exchange? Why couldn't a state just use such a web-based model for "qualified" plans for their state residents?
The web site for an insurance exchange will functionally be a lot like ehealthinsurance.com, but the real work is under the covers.

The exchange is going to have to do some tracking and management of its own operation, insurance companies, and customers. They have to look out for adverse selection problems. They'll tie into some national "building blocks" to check eligibility for special programs like Medicaid and CHIP, as well as subsidy qualification. There are to be public outreach and accountability programs.

http://www.healthcare.gov/law/resour...exchanges.html
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Old 11-11-2012, 08:30 PM   #26
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There are still many initiatives in the PPACA that will be implemented in 2013 and 2014. One that has been the subject of much discussion here is State Health Insurance Exchanges. The States can run their own exchanges, individually or in partnership with other States, or allow the Federal Gov’t to run them.

Each state must inform its intention by Nov 16.
...
8 No Significant Activity: Georgia, Kansas, Missouri, North Dakota, Ohio, Oklahoma, Wisconsin, Wyoming
...
8 Decision Not to Create State Exchange: Alaska, Florida, Louisiana, Maine, New Hampshire, South Carolina, South Dakota, Texas
Last week's election in Missouri for the state constitutional amendment Prop E will move Missouri into the "Not to Create State Exchange" list:

Shall Missouri Law be amended to prohibit the Governor or any state agency, from establishing or operating state-based health insurance exchanges unless authorized by a vote of the people or by the legislature?
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Old 11-11-2012, 08:41 PM   #27
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Paquette-

Thanks for link, but looks like info dates back to early 2011 (e.g. "The Secretary intends to issue regulations for public comment under Section 1321(a) in 2011, but is providing this guidance earlier to assist States and Territories with their overall planning, including legislative plans for 2011."). Obviously things have happened since then
As slow as Feds move, I'm thinking offering open enrollment by Oct '13 might be optimistic.

Sebelius (HHS) is already pushing back deadlines for States submitting their details on exchanges:
http://www.foxnews.com/politics/2012...th-care-plans/
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Old 11-11-2012, 11:16 PM   #28
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Virginia will defer to a federally-run exchange.

Link to Washington Post article here.
There are about 10 states that have laws or constitutional amendments that prohibit state employees from either running a state exchange or enforcing the individual mandate. And, unless something has changed, Congress hasn't appropriated any money for the federal government to set up exchanges for the states.

Since most Americans favor repeal of the law, it may be difficult to get the funding passed (in the House) to allow the federal government to set up exchanges. On the other hand, once some states set them up and the federal subsidy checks start flowing in, residents of the states dragging their heels may pressure their legislators to get off the dime so they can get the subsidies, too (especially since their own tax dollars are used to pay them)
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Old 11-12-2012, 02:32 PM   #29
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Paquette-

Thanks for link, but looks like info dates back to early 2011 (e.g. "The Secretary intends to issue regulations for public comment under Section 1321(a) in 2011, but is providing this guidance earlier to assist States and Territories with their overall planning, including legislative plans for 2011."). Obviously things have happened since then
As slow as Feds move, I'm thinking offering open enrollment by Oct '13 might be optimistic.

Sebelius (HHS) is already pushing back deadlines for States submitting their details on exchanges:
http://www.foxnews.com/politics/2012...th-care-plans/
It depends on the state. Some states decided to wait until after the recent election before beginning to even study what was needed. They will definitely need more time. Others were already working on an exchange before the PPACA was passed. California's exchange may go live in August 2013, with open enrollment starting October 1, 2013.
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Old 11-12-2012, 05:28 PM   #30
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It depends on the state. Some states decided to wait until after the recent election before beginning to even study what was needed. They will definitely need more time. Others were already working on an exchange before the PPACA was passed. California's exchange may go live in August 2013, with open enrollment starting October 1, 2013.
I suspect a lot of states will consider exchanges but likely not implement them right away. Part of this is because, as you said, a lot of states waited until after the election before investing time and money into it, and part of it may be the "you go first" factor: states may want to see the cost and efficacy of other state plans before deciding whether it's worth doing for their own state. As long as they have the federal exchange as a fallback, there's no rush to be on the "bleeding edge," so you might as well let other states be the guinea pigs.
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Old 11-12-2012, 09:15 PM   #31
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IMHO- Might take until mid-2013 (or longer) to see just how this will shake out. Much bureaucratic work still needs to be done for Oct '13 open enrollment to be workable. Some say Repub's in House could still refuse any funding for PPACA. Even if House goes along, fed debt talks could still severely reduce funding for full implementation. Then there's issue of individual states dragging their feet. IMHO- More ?'s than answers for those planning to rely on PPACA for their ER HI.
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Old 11-12-2012, 10:58 PM   #32
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If you would like an example of an exchange just go on the MA Connector site
and browse around. You'll see the costs and benefits for all the plans available in MA. It makes buying insurance easy and there's no worry about the premiums being dependent on the state of your health. Direct cost comparisons is a great way to control costs.

https://www.mahealthconnector.org/portal/site/connector
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Old 11-12-2012, 11:09 PM   #33
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OK, I looked. I'm not familiar with the details in MA, but they seem reasonable to me ( better than being denied coverage ), $360 for a bronze plan. Didn't see any high deductible plans. Seems to be a wide range in price for basically the same coverage, $346 - $551, different companies.

I do plan on being "poor" enough for subsidies, unless they start means testing
For a single the max deductible in MA is $2k and the max annual out of pocket expense is $5k so there's no really high deductible plans offered. The range in cost between different providers for the same coverage reflects the hospitals in network, some hospitals are more expensive. Of course you can go out of network with a co-pay. MA has some of the most expensive (and arguably some of the best) healthcare in the country, but premium increases last year were 2% and they are soon going to be linked to the state's growth in GDP.

If you apply for subsidized Commonwealth Care you have to fill out a form and declare all your income sources and also prove you are an MA resident.
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Old 11-13-2012, 06:39 AM   #34
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If you would like an example of an exchange just go on the MA Connector site
and browse around. You'll see the costs and benefits for all the plans available in MA. It makes buying insurance easy and there's no worry about the premiums being dependent on the state of your health. Direct cost comparisons is a great way to control costs.

https://www.mahealthconnector.org/portal/site/connector
I did that and was encouraged. The cost of a policy with similar coverage to what we have now was quite a bit lower and, for a similar amount of premium we could get much better coverage.
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Old 11-13-2012, 06:48 AM   #35
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I did that was encouraged. The cost of a policy with similar coverage to what we have now was quite a bit lower and, for a similar amount of premium we could get much better coverage.
It will be interesting to see what happens to geographical price differentials once the exchanges are implemented.

I've definitely found myself thinking that for 90% of my healthcare a lower cost suburban hospital network is just fine.......and if I get something exotic I can pay the co-pay and go to Mass General. I imagine a lot of people go through similar reasoning which must put pressure on the more expensive hospitals and insurance policies.

It's also nice to get enrolled right from the website with a mouse click.
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Old 11-13-2012, 07:05 AM   #36
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It will be interesting to see what happens to geographical price differentials once the exchanges are implemented.

I've definitely found myself thinking that for 90% of my healthcare a lower cost suburban hospital network is just fine.......and if I get something exotic I can pay the co-pay and go to Mass General. I imagine a lot of people go through similar reasoning which must put pressure on the more expensive hospitals and insurance policies.

It's also nice to get enrolled right from the website with a mouse click.
I agree. One minor frustration is the PPACA categorizes the US into high, medium and low cost regions (to be used to determine cost of premium) but I can find no public source that shares that information with the rest of us.
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Old 11-13-2012, 07:25 AM   #37
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If you would like an example of an exchange just go on the MA Connector site
and browse around. You'll see the costs and benefits for all the plans available in MA. It makes buying insurance easy and there's no worry about the premiums being dependent on the state of your health. Direct cost comparisons is a great way to control costs.

https://www.mahealthconnector.org/portal/site/connector
That's an interesting site. I looked at the various options, read the FAQs, checked various zip codes throughout MA... everything looks very expensive. DW and I chose a $10k deductible for our Georgia-based policy and I realize that's not available in MA. But even when I compare $4k deductible plans the GA plans are $200-300 less expensive. Then there's the co-insurance thing for MA - this medical insurance problem is way out of control!

Going on a tangent here but I would certainly like to see the PPACA law changed to allow individuals to buy insurance (real insurance) rather than mix all this health care mumbo jumbo of co-pays, wellness care, etc. I just want insurance against major medical catastrophe. It's my responsibility to keep myself healthy, pay for regular doctor visits, etc. IMO insurance is for unexpected issues in life - not routine occurances.

I know human beings and houses are not the same but I'm going out on a limb here - who buys house insurance expecting it to repaint the walls, re-stain the deck, or pressure wash the sidewalk. All of those things are good for your house/property but you don't buy insurance for them. We've lost sight of the fact that health care (i.e. general wellness of your body) and health insurance are two different things. Yes they overlap but they're not the same.
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Old 11-13-2012, 07:28 AM   #38
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Back to the OP... I recently read an article in the local newspaper (Georgia) that our state is undertaking a crash course on whether they will engage in an exchange or not. I'll certainly be interested in seeing the outcome.
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Old 11-13-2012, 09:02 AM   #39
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I know human beings and houses are not the same but I'm going out on a limb here - who buys house insurance expecting it to repaint the walls, re-stain the deck, or pressure wash the sidewalk. All of those things are good for your house/property but you don't buy insurance for them. We've lost sight of the fact that health care (i.e. general wellness of your body) and health insurance are two different things. Yes they overlap but they're not the same.
I totally agree.

I've known people who think nothing of dropping $500 for car maintenance, but then won't go to the doctor for some illness because "they may have to pay."

We're screwed up.

I liked my near-catastrophic plan at Megacorp. Basically pay for most little stuff and let insurance worry beyond that. But now they've complicated it with co-insurance too. Going to take a spreadsheet to figure everything out.
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Old 11-13-2012, 09:20 AM   #40
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That's an interesting site. I looked at the various options, read the FAQs, checked various zip codes throughout MA... everything looks very expensive. DW and I chose a $10k deductible for our Georgia-based policy and I realize that's not available in MA. But even when I compare $4k deductible plans the GA plans are $200-300 less expensive. Then there's the co-insurance thing for MA - this medical insurance problem is way out of control!

Going on a tangent here but I would certainly like to see the PPACA law changed to allow individuals to buy insurance (real insurance) rather than mix all this health care mumbo jumbo of co-pays, wellness care, etc. I just want insurance against major medical catastrophe. It's my responsibility to keep myself healthy, pay for regular doctor visits, etc. IMO insurance is for unexpected issues in life - not routine occurances.

I know human beings and houses are not the same but I'm going out on a limb here - who buys house insurance expecting it to repaint the walls, re-stain the deck, or pressure wash the sidewalk. All of those things are good for your house/property but you don't buy insurance for them. We've lost sight of the fact that health care (i.e. general wellness of your body) and health insurance are two different things. Yes they overlap but they're not the same.
+1 To me health insurance serves two purposes - 1) avoid catastrophic financial loss if DW or I were to have an accident or major illness and 2) gain access to negotiated rates for medical services rather than being charged the rack rate and having to negotiate every time we need service.

My 2013 premiums will be 13% higher than 2012, principally due to mandated increases to benefits (all of which will be of no benefit to me in my personal situation so I am ending up subsidizing the expansion of benefits).

The problem is that too many medical care consumers are spoiled by getting almost free medical services for a low co-pay or co-insurance charge so the mindset isn't that if they have the human equivalent of oil changes, brake pads and rotors, etc. that they should pay for those things out of pocket and many consumers are so short-sighted that they will defer "maintenance" unless it is free or close to free.

I would like to see health insurance structured as two pieces - 1) a high deductible plan that allows consumers to avoid catastrophic financial loss and gain access to negotiated rates and 2) optional coverage for more routine items that is in effect similar to a budget plan for services. While I concede that the bronze/silver/gold plans amount to the same thing, I think it is less transparent than a HDHP with a budget plan rider.

Contraception is a good example. One of the expanded benefits that is driving my 2013 increase in premiums is mandated contraceptive benefits. Back in the old days, we paid for this out-of-pocket and it was our personal responsibility. It's not hugely expensive and there are outlets for those who have trouble affording it.
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