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Old 07-20-2013, 12:03 PM   #21
Thinks s/he gets paid by the post
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Originally Posted by nvestysly View Post
DW and I received a refund from United Health Care this year. The check was not very large - apparently we only overpaid by $10/month or so. I suspect insurers will err on the side of overpayment and send a rebate rather than find themselves in the hole.

I like the intent of the 80/20 rule but I think there are many unintended consequences for this rule. I can imagine lobbyists whitteling away at the ratio - is 75/25 on the horizon. I can also imagine scenarios where the insurer no longer has an impetus to reduce reasonable/customary amounts because they can simply pay higher claim amounts and say "we spent" 80%. So the amounts doctors charge (or are willing to accept) will increase because the insurer can simply redefine their 80% amount.

What's the difference between this and the current situation of seemingly ever-increasing premiums? I think not much. For a few years the masses will be appeased because of the rebates. Maybe the rebates will even continue indefinitely as it becomes the new business model - overcharge and rebate the excess. But I don't think it has a dramatic affect on the overall practice of individuals expecting "insurance" to pay for all medical visits/procedures regardless of how much the procedure costs.

Until individuals are part of the loop - seeing how much procedures cost - understanding that everything is not "free" - medical insurance premiums will continue to rise at much higher rates than inflation because we're spending other peoples money. When you spend other peoples money you don't spend it as wisely as when it's your own money.

So for now I guess I'll be happy that I received a rebate. Do I expect any real changes? NO!
Believe me. An $11,000 family deductible makes one think long and hard about what is medically necessary and we are under no misconception that "insurance" pays for our healthcare! I just need the tools to be a good shopper. Humana has some on their website but not enough. I agree with you that we all need to have sufficient skin in the game to make good choices that positively impact our entire community.

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Old 07-20-2013, 12:35 PM   #22
Thinks s/he gets paid by the post
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Originally Posted by bUU View Post
Does anyone know if there are provisions in the law requiring that prices for individual coverage be in some way linked to prices offered for group coverage? I would hope that the exchanges, themselves, be treated as if it were a big group.
I don't believe there are specific requirements in the law that link 'group coverage' to exchange pricing - the only requirement I'm aware of is the over-55 be no more than 3x the youngest group.

I also would be surprised if there is something linking group coverage policies - each company's policy would be different, as some organizations have many younger people, while some have many older people, along with different medical claim histories. That would result in radically different group rates from year to year for any given company.

To try and link the various differences in rates between corporate plans to the individual markets would be a nightmare beyond belief, IMO. And also conflict with the 3:1 ratio between older and younger rates, since everyone in a group plan is charged the same rate regardless of age.

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Old 07-20-2013, 12:39 PM   #23
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Originally Posted by MooreBonds View Post
I also would be surprised if there is something linking group coverage policies - each company's policy would be different, as some organizations have many younger people, while some have many older people, along with different medical claim histories.
Isn't age just a dimension like other demographics (smokers)? Medical claim histories are another matter, but I would expect the law to expect that over large groups the histories shouldn't be different enough to justify rate differences.

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