Health Plans Up Significantly in 2014

[gerrym51]

I am curious how this has worked in Massachusetts with Romneycare. From what little I have admittedly seen, the process there seem pretty straight forward. And isn't this what the ACA is more or less derived from?

i have purchased in mass. using the health care connector.

it was simple-but i did not qualify or ask for subsidy

i detailed the process on another thread signing up for health connector mass.

i,m not sure on links. its currently on page 2 of this health section

 

[brewer12345]

They are not going to be standardized, they just have to meet the actuarial value requirements and include the Essential Health Benefits, so each company will still have different benefits. Medicare supplement plans are standardized and most people use an agent to buy those too. Few people will understand the subsidies or plan benefits and will need help...just the way it is.

Ah. Thanks. I thought the various levels of plans were going to be standardized the way Med Sup policies are today.

 

[Mulligan]

New York is the most expensive state in the country for health insurance so a reduction in cost there is no surprise. Their DOI is a nightmare for insurance companies so there is limited choice of carriers/plans. Their current laws require companies to charge the same price regardless of health or age, so a 25 year old pays the same price as a 64 year old, which is why the individual health insurance market in NY is pretty much non-existent.

Tell that to the people making $90k/year that are still struggling. $90k/year doesn't go that far in a high cost of living area, and it's still an extra $300/mo that isn't available for other discretionary spending or savings. Taxes also have to be raised to cover the subsidized part of the premium. If the premium is $1200/mo and the family was previously paying $400/mo and is now forced to pay $700/mo, that means $500/mo has to come from taxpayers. Please don't tell me that the extra $800/mo will have no effect on both an individual and national level because it obviously will. There's no free lunch.

To add to your thoughts, the base compounding of future increases will be dramatic too. Take the annual 10% increase model as an example. In 7 years that $400 a month premium is $800. That $1200 a month premium is $2400. A difference of now $1600 a month! Not exactly chump change. Now hopefully increase wont mirror the recent past, but even 5% annual will show a dramatic increase differential over a small course of time.

 

[MichaelB]

Why? If all individual plans sold in the new world are standardized, what is so difficult to understand?

All plans sold in the state health exchanges must satisfy a list of "essential health benefits" established by HHS. They are

The Act defines certain categories of benefits as "Essential Health Benefits." The categories of essential health benefits are:

Ambulatory patient services
Emergency services
Hospitalization
Maternity and newborn care
Mental health and substance use disorder services, including behavioral health treatment
Prescription drugs
Rehabilitative and habilitative services and devices
Laboratory services
Preventive and wellness services and chronic disease management
Pediatric services, including oral and vision care

Here is a PDF by UHC with some detail and explanation http://www.uhc.com/live/uhc_com/Assets/Documents/EssentialHealthBenefits_Overview.pdf

The UHC section on essential benefits Essential Health Benefits

The policies are then offered in four categories, broken down by % coverage of the actuarial value. Not as comprehensive as a Medicare supplement, but nonetheless far more comprehensive and standardized than what we have today.

 

[brewer12345]

All plans sold in the state health exchanges must satisfy a list of "essential health benefits" established by HHS. They are


Here is a PDF by UHC with some detail and explanation http://www.uhc.com/live/uhc_com/Assets/Documents/EssentialHealthBenefits_Overview.pdf

The UHC section on essential benefits Essential Health Benefits

The policies are then offered in four categories, broken down by % coverage of the actuarial value. Not as comprehensive as a Medicare supplement, but nonetheless far more comprehensive and standardized than what we have today.

Thanks.

So enrollment will be open every year, right? If one chooses to switch plans from one year to the next there will be no underwriting allowed and you can swap at will. That implies that I could take a cheaper bronze plan and if I developed a health problem that required lots of expensive care I could swap to a much more comprehensive plan at my option. That correct?

 

[ziggy29]

Now hopefully increase wont mirror the recent past, but even 5% annual will show a dramatic increase differential over a small course of time.

Especially when income isn't growing for most people, let alone keeping up with the CPI.

 

[MichaelB]

Thanks.

So enrollment will be open every year, right? If one chooses to switch plans from one year to the next there will be no underwriting allowed and you can swap at will. That implies that I could take a cheaper bronze plan and if I developed a health problem that required lots of expensive care I could swap to a much more comprehensive plan at my option. That correct?

Specific procedures have not been announced, but we do know some things. Enrollment "typically" has been a 45 day window, beginning Sept/ Oct, for Jan 1 effective date. I would bet this is how it is rolled out.

For certain, you can change from to any plan effective Jan 1, no questions asked, no underwriting. The means from bronze to platinum plans or the other way around. Whoever manages the state exchange decides what plans are offered, but they must meet HHS guidelines, and at least two must offer national coverage.

Members of congress and their staffs must procure their coverage from their state exchange.

 

[fisherman]

As a health insurance agent, I can confirm that this is true, and would add that the estimates of increases stated are on the low side. My average client is a family with parents about 40 years old with two kids and spending an average of $300-600/month. In 2014, the cost for this family with no subsidy will likely be well over $1,000/month, which most people simply can't afford and will not pay. Just because you make $100k combined doesn't mean you're going to be able to spend $15k/year on health insurance, not including any costs that apply towards the out-of-pocket maximums.

California's "health exchange" website is now active and features this fun calculator - Health Insurance Calculator | Covered California

A married couple age 60 making $62,000 can expect a monthly premium of $1,723, a tax credit of $1,232/month and estimated final premium of $491/month. A married couple age 60 making $62,500 can expect a monthly premium of $1,723 , a tax credit of $0, and estimated final premium of $1,723/month. Any econ majors want to calculate that marginal tax rate? That is for a policy with a $12,800 annual out of pocket max, which is higher than most of the individual plans offered today. Only $20k/year in premiums and $13k out of pocket? Sounds pretty affordable. Surely everyone eligible for a salary increase from $62k to $63k would love to have such a promotion.

As of now, 2014 expected pricing has been released in two states, CA and TX. In both states, the 2014 cost of coverage is literally 3x the current cost. Many of these plans will likely have limited regional networks and restricted pharmacy coverage.

Here's a link to Humana's plans in Texas - https://www.humana-one.com/secured/individual-health-insurance-quotes.aspx

Try inputting some fake info and getting a quote, you can use zip code 77005. All of the 2014-compliant plans are labeled with Bronze, Silver, Gold, or Platinum. Notice the price of all of the other existing plans in comparison to the 2014 ones.

Example: 60-year-old couple with two kids. Current plans - $635-1,987/month. 2014 plans - $1,693-5,236/month.

Example 2: 28-year-old couple with two kids. Current plans - $271-949/month. 2014 plans - $1,162-3,589/month.

Humana did not go through the trouble of creating these plans and getting the pricing approved by the state DOI for no reason. Small group health insurance plans are also going to see large price increases since PPACA states that group policies can no longer be medically underwritten starting in 2014, and the same 3-1 age banding premiums and unisex rates must apply to small group coverage.

Will give it a try and some reading but first question is how can the Texas Exchange be up and running as they deferred to the Feds to run it. Have they already seceded again and this is their new country plan?

 

[REWahoo]

Have they already succeeded again and this is their new country plan?

Whether or not they've succeeded is a matter of debate, but they definitely haven't seceded.

 

[fisherman]

Gotta love spell check. I should have watched it more closely. Thank you REW.

 

[fisherman]

When I selected the Platinum plan 0 deducible and clicked apply for the plan I got the following:

Application Checklist

So that you can complete the application easily and completely, be sure you have the following information available for each person applying for coverage.

• Birth Date
• Your Social Security Number
• Height/weight for each person
• Information on current and past health insurance plans (if applicable)
• Medical history, such as dates of diagnosis, treatment, dates of service, and current status
• Prescription drug information such as:
  drug names, dosages, and date initially prescribed.
• Physician/treatment facility contact information
• Payment information: For credit card payments, we accept Visa and MasterCard; for automatic bank withdrawal, please have your bank account number and bank routing number

This does not seem to be an ACA plan as they are asking for items that will not be used in ACA plans like medical history, height weight, etc.

Not sure what these plans have in common with future ACA plans other than including the same color names.

 

[ziggy29]

Here's a link to Humana's plans in Texas - https://www.humana-one.com/secured/individual-health-insurance-quotes.aspx

Try inputting some fake info and getting a quote, you can use zip code 77005. All of the 2014-compliant plans are labeled with Bronze, Silver, Gold, or Platinum. Notice the price of all of the other existing plans in comparison to the 2014 ones.

Example: 60-year-old couple with two kids. Current plans - $635-1,987/month. 2014 plans - $1,693-5,236/month.

Example 2: 28-year-old couple with two kids. Current plans - $271-949/month. 2014 plans - $1,162-3,589/month.

I think this calculator may be broken.

I ran Example 1 and confirmed the cheapest "Bronze" was $1,693 for two 60-year-olds with two kids.

With no kids -- but the two 60 year olds still insured -- the premium on the cheapest "Bronze" plan dropped to $613!

Then I removed ONE kid and it dropped to $1585. So the second kid costs an extra $108 (which is believable)... but the FIRST kid added costs $972?!?!

Insuring two 60-year-olds is $613 per month, but adding two kids is another $1,080?

I also don't think they are already pricing in 2014 rates for coverage that begins within the next few weeks (you can't ask for coverage starting as far into the future as 1/1/2014).

It's busted, IMO. No way this is really how the actuaries drew it up. Is it?

 

[gerrym51]

I think this calculator may be broken.

I ran Example 1 and confirmed the cheapest "Bronze" was $1,693 for two 60-year-olds with two kids.

With no kids -- but the two 60 year olds still insured -- the premium on the cheapest "Bronze" plan dropped to $613!

Then I removed ONE kid and it dropped to $1585. So the second kid costs an extra $108 (which is believable)... but the FIRST kid added costs $972?!?!

Insuring two 60-year-olds is $613 per month, but adding two kids is another $1,080?

I also don't think they are already pricing in 2014 rates for coverage that begins within the next few weeks (you can't ask for coverage starting as far into the future as 1/1/2014).

It's busted, IMO. No way this is really how the actuaries drew it up. Is it?

i looked at this humana plan- . i don't think it's an ACA plan. just current law individual coverage.

 

[ziggy29]

i looked at this humana plan- . i don't think it's an ACA plan. just current law individual coverage.

Regardless, that calculator is screwed up. I can't believe the pricing based on what I discovered above.

 

[gerrym51]

Regardless, that calculator is screwed up. I can't believe the pricing based on what I discovered above.

i actually think it was correct. when you add family coverage its a big jump then incremental for additional children.

i think you are making an assumption that its 108 for each child

 

[dgoldenz]

The Humana plans posted are designed to comply with ACA and that is why they are labeled as bronze/silver/gold/platinum. You can't actually apply for any of these plans yet. From what I was told, Humana set up test markets in a few counties in Texas, but no further details were given. The plans posted on their website could change benefits or pricing before January, but the point is that the 2014 rates are going to be significantly higher than 2013 rates for most people under age 50 that are in reasonably good health.

 

[gerrym51]

The Humana plans posted are designed to comply with ACA and that is why they are labeled as bronze/silver/gold/platinum. You can't actually apply for any of these plans yet. From what I was told, Humana set up test markets in a few counties in Texas, but no further details were given. The plans posted on their website could change benefits or pricing before January, but the point is that the 2014 rates are going to be significantly higher than 2013 rates for most people under age 50 that are in reasonably good health.

and based on ziggys experience is the pricing correct. since you sell healthplans is the first child making it familly plan the biggest price jump

 

[Mulligan]

The Humana plans posted are designed to comply with ACA and that is why they are labeled as bronze/silver/gold/platinum. You can't actually apply for any of these plans yet. From what I was told, Humana set up test markets in a few counties in Texas, but no further details were given. The plans posted on their website could change benefits or pricing before January, but the point is that the 2014 rates are going to be significantly higher than 2013 rates for most people under age 50 that are in reasonably good health.

Dgoldenz, what is your thoughts on the underwritten health insurance plans that are grandfathered? Do you think they will be able to survive for a period of time? Do you think the government wants those individual market " healthy people" thrown into the exchange to help pay for the premiums for the others? I would really like mine to hold up for 7 years until I get to 55 where I wouldn't get killed so bad when/if I get forced into participating.

 

[rbmrtn]

Regardless, that calculator is screwed up. I can't believe the pricing based on what I discovered above.

I've seen some "quirks" in the preview calculators like this one, National Health Care Calculator

The premium never changes for family size from 2 to 8 members. The subsidy adjusts.

 

[dgoldenz]

and based on ziggys experience is the pricing correct. since you sell healthplans is the first child making it familly plan the biggest price jump

Nobody knows yet. Humana usually charges for each child individually, while other companies consider any plan with at least 2 adults plus 1 child on it to be a "family" plan and priced accordingly. It's possible that for 2014 there could be a base "family" rate with an upcharge for each additional child. We'll just have to see how it plays out. Supposedly the official plan designs and rates must be submitted to HHS no later than April 1, so it won't be too long before we find out.

 

[dgoldenz]

Dgoldenz, what is your thoughts on the underwritten health insurance plans that are grandfathered? Do you think they will be able to survive for a period of time? Do you think the government wants those individual market " healthy people" thrown into the exchange to help pay for the premiums for the others? I would really like mine to hold up for 7 years until I get to 55 where I wouldn't get killed so bad when/if I get forced into participating.

Grandfathered plans will eventually hit the insurance death spiral since there are no new, healthy people to be added to the plans. I would probably give it 3-4 years before most people with a grandfathered plan end up dumping it. However, since the unhealthy people can now buy policies on the exchange, I could be wrong. Will depend on pricing of existing plans versus the new guaranteed-issue policies.

 

[Buckeye]

Insurance companies are highly regulated and the state regulators go over their books all the time, especially when annual rate increases are applied for. I don't think it will be a problem.

I wish it were true in Florida. Do we HAVE an insurance commissioner?

 

[brewer12345]

I wish it were true in Florida. Do we HAVE an insurance commissioner?

Just because you do not like the price does noyt mean it isn't actuarially supported. If anything, homeowners, etc. prices in FL are too low.

 

[Buckeye]

Just because you do not like the price does noyt mean it isn't actuarially supported. If anything, homeowners, etc. prices in FL are too low.

Definitely agree with you on homeowners insurance being priced too low. If USAA won't write because they can't charge appropriate to the risk, something is wrong with the system.......and how our insurance commissioner is doing his/her job!

 

[brewer12345]

Definitely agree with you on homeowners insurance being priced too low. If USAA won't write because they can't charge appropriate to the risk, something is wrong with the system.......and how our insurance commissioner is doing his/her job!

My recollection is that FL is one of the states that has an elected insurance commissioner (most are appointed by the state's governor). You have what the electorate paid for.