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Proposed premiums for DC residents
Old 06-08-2013, 08:15 AM   #1
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Proposed premiums for DC residents

Proposed premiums for policies at the Washington DC exchange were released the other day. They can be found here Proposed January 2014 Rates for Health Insurance Products to be Sold in DC Health Benefit Exchange | disb

The exchange press release is here Proposed January 2014 Rates for Health Insurance Products to be Sold in DC Health Benefit Exchange | disb
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Old 06-08-2013, 09:00 AM   #2
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Do you know what the acronym SHOP means in the title on page 2 of the rates. I'm assuming it means something like "family" since the first page is titled "Individual."
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Old 06-08-2013, 09:18 AM   #3
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SHOP is Small Business Health Option. It's objective is to enable small business owners to offer access to multiple plans to their employees. Mandatory implementation has been delayed for one year, but it appears some exchanges are moving ahead.
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Old 06-08-2013, 09:24 AM   #4
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At first blush MichaelB, these rates don't look too bad. Thanks for posting this link. I need to see if Anthem is going to be on the exchanges. For a comparison, I now pay $392/month for an individual non grandfathered policy with a $3,500 deductible without th extras such as maternity and well baby tacked on.

I'm older than the 55 age group, the oldest in these charts. I wonder what the rates are going to be between 55 and 65. Do you know if 55 is the last "age break"?
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Old 06-08-2013, 09:37 AM   #5
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SHOP is Small Business Health Option. It's objective is to enable small business owners to offer access to multiple plans to their employees. Mandatory implementation has been delayed for one year, but it appears some exchanges are moving ahead.
Thanks. Now I see the acronym explained on the main page. So is a Family rate just X times the Individual rate? Am I missing something obvious (like the SHOP explanation)?
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Old 06-08-2013, 10:00 AM   #6
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At first blush MichaelB, these rates don't look too bad. ...
+1 but still higher than my proposed 2014 rates but DC is a more expensive area.

I don't understand what Low-High-Average mean. Wouldn't all 55 yo using a PPO through Aetna (as an example) pay one rate?
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Old 06-08-2013, 10:51 AM   #7
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This article has links to the three proposals put forth so far in Connecticut. If I am comparing them properly (and I would be greatly assisted in the effort if they had been compelled to use a common format and methodology; sadly, they weren't), the base rates are $291.06, $279.54 and $264.77 for the standard 70% actuarial value, Silver level plan. The standard federal age rating factors apply (so, for example, a 59 year old pays 2.603 times the base rate) and there is no tobacco use rating factor. There are very minor geographical adjustment factors (CT is a very small state)

https://www.ctmirror.org/story/aetna...exchange-plans

Edit to add: A fourth was filed within the last three days. I think the comparative Silver plan base rate would be $242.00, but it is very difficult to tell.

See link at http://www.ctmirror.org/story/anthem...surance-prices
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Old 06-08-2013, 10:54 AM   #8
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Originally Posted by sheehs1 View Post
I'm older than the 55 age group, the oldest in these charts. I wonder what the rates are going to be between 55 and 65. Do you know if 55 is the last "age break"?
Current industry practice are 5 year "steps", and last I saw on this was a table with more, much smaller increments, but now that I want it the source escapes me. . Methinks this will be up to the exchange or insurer and the only limit is the 3x range from lowest to highest.

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I don't understand what Low-High-Average mean. Wouldn't all 55 yo using a PPO through Aetna (as an example) pay one rate?
My guess is the low / high represent the range of the separate policies submitted for that group. The press release says
Quote:
Four major insurance companies have submitted proposed rates for approval for nearly 300 health-insurance plans for sale on the DC Health Benefit Exchange
One thing I miss from all the state exchange announcements so far is a rate for the policies that provide nation-wide coverage. The PPACA mandates at least two policies in this category, and I am anxious to see the pricing.
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Old 06-08-2013, 12:09 PM   #9
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There would be policies that would not provide nation-wide coverage? I would think that almost anyone might travel some, even if to attend weddings, funerals or whatever. Please educate me on this.
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Old 06-08-2013, 12:57 PM   #10
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There would be policies that would not provide nation-wide coverage? I would think that almost anyone might travel some, even if to attend weddings, funerals or whatever. Please educate me on this.
Very much. Healthcare insurance is a function of what is covered and where one can receive service. IOW, the network. Many policies are regional or state specific (especially small business and individual) everything outside the immediate area is out of network and subject to different coverage terms, separate additional deductibles, etc, excepting emergency care. One way for insurance companies to offer a low cost policy is with a small network, which effectively limits how much in-network medical care can be provided over the term.

One of the mandates of the PPACA is each state exchange must offer two policies with nation-wide coverage, meaning a national network, and one of the policies must be a not-for-profit carrier. Those policies are probably in the submissions and proposed rates we are seeing, likely the most expensive options, but no details have yet been released so we don't know.

As we approach the Oct initial enrollment date hopefully we can find an easy way to define the network size and compare them between policy options.
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Old 06-08-2013, 12:58 PM   #11
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Michael - thanks for keeping up up to date on PPACA. You've been a wealth of info and education on this. The DC rates are encouraging. I'm hoping Florida is no more expensive than this. Do you know where I can find the list of high / medium / low cost states ?
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Old 06-08-2013, 01:39 PM   #12
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Originally Posted by MichaelB View Post
Very much. Healthcare insurance is a function of what is covered and where one can receive service. IOW, the network. Many policies are regional or state specific (especially small business and individual) everything outside the immediate area is out of network and subject to different coverage terms, separate additional deductibles, etc, excepting emergency care. One way for insurance companies to offer a low cost policy is with a small network, which effectively limits how much in-network medical care can be provided over the term.

One of the mandates of the PPACA is each state exchange must offer two policies with nation-wide coverage, meaning a national network, and one of the policies must be a not-for-profit carrier. Those policies are probably in the submissions and proposed rates we are seeing, likely the most expensive options, but no details have yet been released so we don't know.

As we approach the Oct initial enrollment date hopefully we can find an easy way to define the network size and compare them between policy options.
Have you heard anything about HSA plans? It doesn't appear much has been mentioned on them, yet. Is it possible they are in the pipeline like the nationwide coverage plans?
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Old 06-09-2013, 05:50 AM   #13
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Originally Posted by MichaelB View Post
Very much. Healthcare insurance is a function of what is covered and where one can receive service. IOW, the network. Many policies are regional or state specific (especially small business and individual) everything outside the immediate area is out of network and subject to different coverage terms, separate additional deductibles, etc, excepting emergency care. One way for insurance companies to offer a low cost policy is with a small network, which effectively limits how much in-network medical care can be provided over the term.

One of the mandates of the PPACA is each state exchange must offer two policies with nation-wide coverage, meaning a national network, and one of the policies must be a not-for-profit carrier. Those policies are probably in the submissions and proposed rates we are seeing, likely the most expensive options, but no details have yet been released so we don't know.

As we approach the Oct initial enrollment date hopefully we can find an easy way to define the network size and compare them between policy options.
Thanks MB. Since I won't need a policy I haven't followed the features closely. I assumed the mult-state plans were more like the national Federal program plans - plans that are offered across the country for a single rate. I assume all of the plans must have some sort of out of network coverage for travel?
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Old 06-09-2013, 07:16 AM   #14
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Gumby, thanks for the link to Connecticut plans and finding the rates.

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Thanks MB. Since I won't need a policy I haven't followed the features closely. I assumed the mult-state plans were more like the national Federal program plans - plans that are offered across the country for a single rate. I assume all of the plans must have some sort of out of network coverage for travel?
The Federal program plans would be a good option. Our congressional representatives and their staffs must use the state exchanges so I'm hoping that assures us of plans similar to what they enjoy today, without subsidy.

Insurers are free to define their networks pretty much any way they choose, and the only out of network coverage they must provide is emergency care. Anything else they can treat as out of network, even if it involves care by providers in another of their networks. Most PPO policies today have two deductibles, one for in network and another larger amount for out of network care.
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Old 07-23-2013, 09:35 AM   #15
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Final rates announced for DC residents. Apparently they are below the preliminary estimates.

The individual rate table can be seen here http://disb.dc.gov/sites/default/fil...Rates71913.pdf

More information on rates here Information on the Proposed Jan. 2014 Rates for Plans on DC Health Link, the District
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Old 07-23-2013, 11:19 AM   #16
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thanks Michael. I was away on a Prague to Vienna bike trip and missed my hometown announcement. It's tough to be FIREd but someone has to do it.
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Old 07-23-2013, 12:52 PM   #17
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I have been watching all these discussions and am wondering what about health insurance for kids?
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Old 07-24-2013, 02:51 PM   #18
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I have been watching all these discussions and am wondering what about health insurance for kids?
In general, if you can't have a family policy of some sort (say, you're on Medicare), you can get them individual insurance.

We bought a high deductible plan for our youngest daughter several years ago. We pay out of pocket for all the usual routine stuff, and the plan is there in case of an emergency or sudden large expense. Because of the plan even our out of pocket expenses are at the 'negotiated rates'. For example, an ambulance trip from school to the ER that would have been $600 was $100. That's something to keep in mind. (She was OK, BTW. The school folks were... being perhaps overcautious...)

These plans continue to be available.
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Old 07-24-2013, 04:00 PM   #19
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Everybody keeps talking about how reasonable the premiums are, maybe for for people under 400% of poverty, and pre existing conditions. I'm a single male of 58, healthy making just over about 50k magi (semi retired). So i guess i either have to work less or more. I work out of state so I can't take the cheapest policy. That is just not affordable after counting witholdings and heath insurance ,its around a 40% tax rate.

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Old 07-24-2013, 04:39 PM   #20
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Alasaka55, I don't think anyone here feels the new rates we are seeing are a bargain. Many of us, however, are paying high rates today, some even higher that what we are seeing on the exchanges. The reality is health care, and health care insurance, is extremely expensive in the US. Hopefully you will have the option of an affordable rate when your state publishes it's premiums.
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