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Old 03-26-2014, 10:39 AM   #21
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...because consumers do not "shop" medical services like they shop for other services.
US consumers of health services generally can not shop. It's not possible to do it effectivly due to lack of information. "Rack rate" prices are pure fiction (even though uninsureds see that number, there's pretty often if not closer to very often an easily attainable discount applied). "Negotiated rate" prices are secret (between provider 'A' and insurance company 'Y'), and not generally available unless you actually get the service as a policy holder of 'Y'. By then, it's too late since you would have had to compare 'A', 'B', and 'C' on cost and quality before having the service performed.

I'm not a fan of legislation, but I don't see a way around this unless we, as health services consumers, get more information on cost and quality. This has nothing to do with legislated cost controls. It's all about giving people information so they can effectivly shop and negotiate price on their own. The providers and insurance companies will not give up the power unless compelled to do so. I'm not holding my breath, given the way our legislative system works.
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Old 03-26-2014, 01:05 PM   #22
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......... I'm not holding my breath, given the way our legislative system works.
What? We have the finest legislature that money can buy.
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Old 03-26-2014, 01:52 PM   #23
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US consumers of health services generally can not shop. It's not possible to do it effectivly due to lack of information. "Rack rate" prices are pure fiction (even though uninsureds see that number, there's pretty often if not closer to very often an easily attainable discount applied). "Negotiated rate" prices are secret (between provider 'A' and insurance company 'Y'), and not generally available unless you actually get the service as a policy holder of 'Y'. By then, it's too late since you would have had to compare 'A', 'B', and 'C' on cost and quality before having the service performed.

I'm not a fan of legislation, but I don't see a way around this unless we, as health services consumers, get more information on cost and quality. This has nothing to do with legislated cost controls. It's all about giving people information so they can effectivly shop and negotiate price on their own. The providers and insurance companies will not give up the power unless compelled to do so. I'm not holding my breath, given the way our legislative system works.
I wouldn't say it is impossible, but I agree that its is very difficult to "shop" and that is a problem with the system - you can't reasonably expect competitive pressures to rein in costs unless consumers can compare prices and services.
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Old 03-26-2014, 02:32 PM   #24
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There is an easy explanation:

The Obamacare legislation "invited" all insurers to participate in the new exchanges. However, it did not dictate how much the insurer can charge. All the insurers did was reprice their policies based on the fact they have to take ALL pre-existing conditions (mandate), and its not too hard for a bunch of smart actuaries to figure out the price HAS to go up due to increased risk exposure. And, NOT ALL insurers decided to offer plans inside the exchanges.......so you have higher costs, due to a lower amount of competition and increased risk exposure.........not too hard to surmise the end result??
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Old 03-26-2014, 05:45 PM   #25
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There is an easy explanation:

The Obamacare legislation "invited" all insurers to participate in the new exchanges. However, it did not dictate how much the insurer can charge. All the insurers did was reprice their policies based on the fact they have to take ALL pre-existing conditions (mandate), and its not too hard for a bunch of smart actuaries to figure out the price HAS to go up due to increased risk exposure. And, NOT ALL insurers decided to offer plans inside the exchanges.......so you have higher costs, due to a lower amount of competition and increased risk exposure.........not too hard to surmise the end result??
But the legislation also includes medical loss ratios. If insurers over-price their product, then they have to rebate the excess to their customers. We got a check last year for just that reason. Additionally, there are "risk corridors" (just like the Medicare Plan D start up) that will compensate insurers who under-priced their product or claw back money that the government spent on insurers who have over-priced.

-----

I'm a consumer. I have chest pain. I call around and I price treatment for lung cancer, pulmonary embolus, heart attack, pneumonia, mediasteinitis, rib fracture and costochondritis. If the pricing were more transparent, it would be a snap ... or would it?
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Old 03-26-2014, 06:25 PM   #26
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The uncertainty of how premiums might increase in the first couple of years in addition to whether the "subsidy" program could be maintained is the primary reason why I am not considering ER until 2016 even though firecalc gives me a 100% success rate. Big difference in the long term before Medicare if premiums run $20K+ vs $4K a year!
This is my fear too. Premiums could go crazy or, possibly even worse, the ACA could be repealed and those with preexisting conditions become uninsurable again. Not a fun situation to be in just starting early retirement without group health insurance.
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Old 03-26-2014, 06:31 PM   #27
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There is an easy explanation:

The Obamacare legislation "invited" all insurers to participate in the new exchanges. However, it did not dictate how much the insurer can charge. All the insurers did was reprice their policies based on the fact they have to take ALL pre-existing conditions (mandate), and its not too hard for a bunch of smart actuaries to figure out the price HAS to go up due to increased risk exposure. And, NOT ALL insurers decided to offer plans inside the exchanges.......so you have higher costs, due to a lower amount of competition and increased risk exposure.........not too hard to surmise the end result??
The OP was not complaining about the current prices being high. In fact they are not necessarily so - many folks were able to find a better deal compared to their old insurance. It was speculation about FUTURE prices going up in 2015 and beyond.

But since they had been going up fast anyway before the ACA law, who can honestly point at the new law as the main culprit?
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Old 03-27-2014, 04:57 AM   #28
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This is my fear too. Premiums could go crazy or, possibly even worse, the ACA could be repealed and those with preexisting conditions become uninsurable again. Not a fun situation to be in just starting early retirement without group health insurance.

If by chance the ACA does get repealed, I think "pre-existing conditions" will be covered no matter what replaces it. In this great county of ours, we can surely find a way to provide medical coverage for everyone that needs it!

Mike
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Old 03-27-2014, 07:01 AM   #29
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If by chance the ACA does get repealed, I think "pre-existing conditions" will be covered no matter what replaces it. In this great county of ours, we can surely find a way to provide medical coverage for everyone that needs it!
I think some of the provisions will prove too popular to repeal. That is one of them. I suspect keeping kids on the policy until age 26 is another, and perhaps the elimination of medical underwriting. The problem is that with the elimination of PEEs and medical underwriting, there has to be *some* "universal coverage" mechanism to make the numbers work, otherwise adverse selection would overwhelm the system.

I think we need to see what will happen when the penalty for being uninsured actually gets some teeth. Frankly if that is going to be the enforcement mechanism, seems to me the penalty should be roughly equal to the cost of the cheapest qualified Bronze policy to eliminate any incentive not to get insured to at least a minimum acceptable level. But they never asked me!
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Old 03-27-2014, 10:29 AM   #30
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The OP was not complaining about the current prices being high. In fact they are not necessarily so - many folks were able to find a better deal compared to their old insurance. It was speculation about FUTURE prices going up in 2015 and beyond.
I would expect future prices to go up even steeper than before ACA. All those "young healthy people" needed to subsidize the unhealthy ones are NOT running to sign up.........and if that trend continues, the policies going forward will have to increase substantially..........
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Old 03-27-2014, 11:20 AM   #31
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I wouldn't say it is impossible, but I agree that its is very difficult to "shop" and that is a problem with the system - you can't reasonably expect competitive pressures to rein in costs unless consumers can compare prices and services.
To toss a bit of "good news" into the thread, I've used a site called "goodrx.com" to honestly shop for good prescription prices! I would urge everyone to look-up the prescriptions they're taking (you do not need to even register on the site...just type in the name of the drug and your zip code).

Even if you have drug coverage, you might try it, because, well, the whole drug pricing thing is so whacky, you might find a lower price by ignoring your insurance and using this.

I don't have any drug coverage at all. I'm getting a 75% discount over what I would have paid without the goodrx coupon. I had to transfer my scrip from one pharmacy to another, so it's a pain, but it's hundreds of dollars in savings.
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Old 03-27-2014, 12:04 PM   #32
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Yes, Prices, Coupons and Information - GoodRx has been mentioned before, with positive recommendations. I get our prescriptions printed and then take them in with the coupon. Two of them have even been processed at slightly below the coupon price. Very happy with the site.

Go ahead and make an account and then you can get email updates to your prescription prices and when you sign in all your Rxs are there with current prices and coupons.

We have Rx coverage but some of the prices through the insurance are 3 times what I pay using GoodRx.
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Old 03-27-2014, 01:10 PM   #33
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Another piece of positive news, went in to a pain management guy today. Was expecting a occipital nerve block. We talked, I had no pain at the time. He said he'd go ahead and perform the procedure today if I insisted. His opinion let's wait, schedule an appointment for next week, do the things that make the pain worse the day before. I'll wait, rather not have the dose of steroids, if it won't help.

That said I don't know what the charges will be either way.
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Old 03-27-2014, 05:22 PM   #34
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If by chance the ACA does get repealed, I think "pre-existing conditions" will be covered no matter what replaces it. In this great county of ours, we can surely find a way to provide medical coverage for everyone that needs it!

Mike
Agreed.
During the pre-ACA debate process, leading health reform proposals from both parties included this provision. And many states had such provisions in place prior to ACA implementation.
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Old 03-27-2014, 07:35 PM   #35
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I would expect future prices to go up even steeper than before ACA. All those "young healthy people" needed to subsidize the unhealthy ones are NOT running to sign up.........and if that trend continues, the policies going forward will have to increase substantially..........
Your hypothesis is a popular one. But is it true?

This Kaiser analysis runs the numbers, concluding that insurer margins would be affected about 2% if the percentage of 18-34 y.o.'s signing up was 25% vs. their 40% representation in the pool of potential customers for exchange policies.

The reason? 20 y.o.'s only pay 1/3 the premiums of 60 y.o.'s.

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From the perspective of keeping insurance premiums stable, how enrollment is distributed by health within each age group is, in fact, more important, since premiums cannot vary at all by health status under the ACA. In other words, the goal is to enroll healthy as well as sick young adults, and also healthy older adults. (Older adults are more likely to be sick than younger people, but that is mostly accounted for by the fact that premiums can vary by age.)

However, questions about health and pre-existing conditions are no longer asked on insurance applications, so we will not know for quite a while whether sicker people are enrolling at a higher rate than healthier people.
The Numbers Behind “Young Invincibles” and the Affordable Care Act | The Henry J. Kaiser Family Foundation
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Old 03-27-2014, 09:50 PM   #36
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Your hypothesis is a popular one. But is it true?

This Kaiser analysis runs the numbers, concluding that insurer margins would be affected about 2% if the percentage of 18-34 y.o.'s signing up was 25% vs. their 40% representation in the pool of potential customers for exchange policies.

The reason? 20 y.o.'s only pay 1/3 the premiums of 60 y.o.'s.

The Numbers Behind “Young Invincibles” and the Affordable Care Act | The Henry J. Kaiser Family Foundation
I've read this KFF study few times and still do not see how their assumptions & numbers reconcile. I've gone back to their source material- (from Soc of Actuaries). Plugging in their relative AG cost factors, AG relative premiums, & KFF's assumed drop on assumed "worst case" AG sign-up proportions I reach a significantly larger effect on global premiums. Even looked at simplistically, all agree that 18-34yo AG premiums are "profit" into the system (i.e. their HI premiums> their HC costs). How can a 50% decrease in "profit" group (25 vs 40% proportion of enrollments) only hurt the system's net by 2%?

The other big unknown is the relative health of Exchange population. It could be that overall Exchange population turns out to be healthier than predicted so HC costs & premiums could be less too. If the opposite is true, then 2015 premiums could get ugly.
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Old 03-28-2014, 06:39 AM   #37
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I've read this KFF study few times and still do not see how their assumptions & numbers reconcile.
One answer could be that women in their twenties aren't the profit source that men are (due to pregnancy expenses), producing a relatively neutral profit profile for the age cohort as a whole? There is a reason the sign-up ads now running on television during the NCAA tournament are using male basketball stars...

Another reason is that there are reinsurance, risk corridor and risk adjustment features in the ACA. These factors are taken into account on the income side of insurer's pricing model. It's not just premiums.

This Milliman analysis crunches the numbers with the "3R's" in mind, finding some surprising results:
http://us.milliman.com/uploadedFiles...ection-aca.pdf

My source for both of links I provided:
Implementing Health Reform: A February Exchange Enrollment Report Health Affairs Blog
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Old 03-28-2014, 07:20 AM   #38
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I sweated the whole of 2013 wondering about the price increases in my wifes individual plan and whether we would be eligible for subsidy under obamacare. I am 67 and on medicare my wife is 62 and has an individual plan. our agi for 2012 was 46k and we were not eligible for subsidy, but my wifes individual plan, which we were happy with only increased by 15. a month. so a wholes years worry for nothing. you can speculate and check sources all you want but until the actual numbers become available you might as well not worry, because it does no good.
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Old 03-28-2014, 11:41 AM   #39
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....... until the actual numbers become available you might as well not worry, because it does no good......
BINGO!!! All of us are hoping for pleasant surprises in 2015 premiums but only time will tell.

Clearly, predicting future premiums is tough since changing HHS implementation policies/reg's will have a major & unpredictable effect. That said, analyses being published on this are of disappointingly poor quality....some might say useful mainly as fertilizer. While the KFF piece is questionable, the Milliman analysis discredits itself in its own concluding remarks.
"The claims experience within MarketScan is derived from plans that do not necessarily conform to forthcoming ACA requirements, such as meeting prescribed actuarial value ranges and covering all essential health benefits mandated by each state." (emphasis added)

http://us.milliman.com/uploadedFiles...ection-aca.pdf


Since AVR's & coverage of EHB's are huge features of ACA, the relevance of this analysis to current ACA universe of HI is tenuous at best.
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Old 03-29-2014, 09:11 AM   #40
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Yes, Prices, Coupons and Information - GoodRx has been mentioned before, with positive recommendations. I get our prescriptions printed and then take them in with the coupon. Two of them have even been processed at slightly below the coupon price. Very happy with the site.

Go ahead and make an account and then you can get email updates to your prescription prices and when you sign in all your Rxs are there with current prices and coupons.

We have Rx coverage but some of the prices through the insurance are 3 times what I pay using GoodRx.
While off-topic - reducing costs of healthcare prescriptions is important and we have found healthwarehouse.com to be lower than the goodrx coupons in the majority of cases - been using them exclusively for over 3 years now and never a problem! - I don't pay for the "tracking" and have never had a shipment go missing. They automatically send the reorders and their is an extra discount on those!
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