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Old 11-27-2015, 04:06 PM   #121
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The ironic part is the administration which pushed for the individual mandate to make it succeed then later kept releasing exemptions from the list which now just about includes everyone if they do not want to pay the penalty.
Making a social change this big was/is a heavy lift. It needs carrots and sticks to work, but while people love the carrots (insurance coverage regardless of pre-existing conditions), they hate the stick (mandatory to buy insurance). So, politics being what they are, compromises were made to make it palatable. I guess this is why sausage making plants don't have windows onto the street.
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Old 11-27-2015, 04:57 PM   #122
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I didn't realize that someone could just buy short-term health insurance to cover up to 12 months as long as they were able to pass the medical underwriting, and pay the penalty for non-compliant insurance. And then hope that nothing comes up during the year so they can renew again 12 months later.
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Old 11-27-2015, 05:30 PM   #123
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I just looked, and saw that we could still buy non-ACA insurance for $220/month for 2, deductible of $5000. Caveat: pre-existing conditions not covered, lifetime limit of $1M.

That is not bad at all, darn cheap in fact! I used to pay 3x that for pre-ACA insurance with a $10K deductible, and the caveat was the same, I thought. What happened?
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Old 11-27-2015, 06:16 PM   #124
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Originally Posted by audreyh1 View Post
I didn't realize that someone could just buy short-term health insurance to cover up to 12 months as long as they were able to pass the medical underwriting, and pay the penalty for non-compliant insurance. And then hope that nothing comes up during the year so they can renew again 12 months later.
Yeah, that's how it works. If you can pass the underwriting you can get a short-term plan for up to 12 months, and if your health stays good enough you can renew it again (paying the penalty) and re-up for another year of it. And if something happens that would disqualify you or exclude a preexisting condition, then you can go on an ACA-compliant plan.

IMO, the ease with which the system can be gamed is part of the problem.
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Old 11-27-2015, 06:31 PM   #125
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I didn't realize that someone could just buy short-term health insurance to cover up to 12 months as long as they were able to pass the medical underwriting, and pay the penalty for non-compliant insurance. And then hope that nothing comes up during the year so they can renew again 12 months later.

You have to remember that the policy does not automatically renew... you have to renew it yourself... and you can go with a different insurer if you want.

Not sure how they would do if you had a major problem such as a heart attack or stroke... one of the tricks for insurance is to just deny a claim....
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Old 11-27-2015, 06:39 PM   #126
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You have to remember that the policy does not automatically renew... you have to renew it yourself... and you can go with a different insurer if you want.

Not sure how they would do if you had a major problem such as a heart attack or stroke... one of the tricks for insurance is to just deny a claim....
Sure, I get that about renewing. But the 12 month long period surprised me. I assumed it would only be for gaps and not be a whole year.

Our ACA policies haven't renewed either. Every year they have changed the plan, forcing us to renew at some level. Last year the plan suddenly changed to copays and be came non-HSA compliant, forcing us to switch to another that still was HSA compliant. I couldn't believe they made such a drastic change. This year they dropped the plan altogether. Way more drastic even.

Heart attack - I guess they deal with what they can and insurance will cover and hope to make it to the open enrollment period.
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Old 11-27-2015, 08:09 PM   #127
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Originally Posted by travelover View Post
Making a social change this big was/is a heavy lift. It needs carrots and sticks to work, but while people love the carrots (insurance coverage regardless of pre-existing conditions), they hate the stick (mandatory to buy insurance). So, politics being what they are, compromises were made to make it palatable. I guess this is why sausage making plants don't have windows onto the street.

The mysterious part was most of the weakening of the penalties and exemptions were done by executive order after the law was passed, not any compromising with partisan politics.


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Old 11-27-2015, 08:17 PM   #128
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Sure, I get that about renewing. But the 12 month long period surprised me. I assumed it would only be for gaps and not be a whole year.

Our ACA policies haven't renewed either. Every year they have changed the plan, forcing us to renew at some level. Last year the plan suddenly changed to copays and be came non-HSA compliant, forcing us to switch to another that still was HSA compliant. I couldn't believe they made such a drastic change. This year they dropped the plan altogether. Way more drastic even.
In theory, if they offer the same plan from one year to the next, on an ACA-compliant policy the renewal should be automatic. But the problem is that if the specific plan is discontinued, more hoops!

With a short term plan, you have to deal with (usually abbreviated) underwriting every year. There are only a few questions to qualify initially, but if you develop a condition during the duration of the policy, that condition will often be excluded from coverage if you want to renew it.
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Old 11-27-2015, 08:25 PM   #129
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I just looked, and saw that we could still buy non-ACA insurance for $220/month for 2, deductible of $5000. Caveat: pre-existing conditions not covered, lifetime limit of $1M.

That is not bad at all, darn cheap in fact! I used to pay 3x that for pre-ACA insurance with a $10K deductible, and the caveat was the same, I thought. What happened?
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... With a short term plan, you have to deal with (usually abbreviated) underwriting every year. There are only a few questions to qualify initially, but if you develop a condition during the duration of the policy, that condition will often be excluded from coverage if you want to renew it.
Ah hah! That was it.

My former pre-ACA plan was more expensive because even when I developed some dreadful disease, as long as I paid the premium, they had to cover me unless they discontinued the plan. With the current short-term, they do not have to.

So, I went back and looked at the current supercheap plan, and indeed one could not get a policy with a coverage of longer than 184 days.
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Old 11-27-2015, 08:26 PM   #130
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Mulligan and Ziggy - thanks for the explanation regarding short term health plans. It never occurred to me that these types of plans would be available. I can see the temptation to do this but I probably wouldn't consider it for myself (and there's no way my wife would pass underwriting).
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Old 11-27-2015, 09:32 PM   #131
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Mulligan and Ziggy - thanks for the explanation regarding short term health plans. It never occurred to me that these types of plans would be available. I can see the temptation to do this but I probably wouldn't consider it for myself (and there's no way my wife would pass underwriting).

It wouldn't be for the timid, and it certainly wouldn't be my first option to save a buck. Besides, NW mentioned something that I thought was true also, but didn't mention. I have never heard of 12 month short term insurance. I thought 6 months was the max term also. When I had to purchase it once was a 3 month gap coverage I thought 6 was the limit. If 6 month is the limit, it would not work seamlessly with ACA anyways if you got denied when re upping in middle of the year.


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Old 11-27-2015, 09:39 PM   #132
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So, I went back and looked at the current supercheap plan, and indeed one could not get a policy with a coverage of longer than 184 days.
I looked at short term plans for Arizona and didn't see any 12 month plans offered. All of the lower priced plans were for 6 months only, a couple plans were offered for 11 months but at a much higher cost.
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Old 11-28-2015, 01:31 AM   #133
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Just throwing this out without a quote....

First, not everybody can get an ACA plan... there are people here that do not have the proper paperwork or whatever and still need want to buy insurance....


I do not know about today, but when I looked during the first year of ACA, they did have 12 months ST plans... I actually signed up for one but dropped it when they would not cover me for pre-existing conditions...
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Old 11-28-2015, 07:33 AM   #134
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I don't understand how this works. Does it pay your hospital bills if you get sick?
The two most common types of non-ACA compliant are short term health and medical indemnity. You don't want a medical indemnity plan in this scenario because it pays a fixed rate per day or per illness/accident and not your medical bills.

Short term health plans are more similar to exchange plans in that they use a provider network, have a deductible and Maximum Out Of Pocket (MOOP). They're not ACA compliant because they're underwritten, not guaranteed renewable, can exclude pre-existing conditions, don't cover preventive services, don't have to include the deductible in the MOOP, and have caps of $1M-$2M per benefit period. Some plans have limited/no Rx coverage.

As Mulligan stated, the insurer isn't going to let you renew it if you use it a lot so you go back to an ACA exchange plan at the next AEP in those cases. Therefore, it's best to choose a 12 month short term plan that starts January 1. Or use an ACA plan for January and move to an 11 month ST plan in February.

Some of the UnitedHealth short term plans use their Choice Plus PPO provider network.

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Sure, I get that about renewing. But the 12 month long period surprised me. I assumed it would only be for gaps and not be a whole year.
While there are 12 month short term plans available, mainly from UnitedHealth, a few states have regulations limiting them to 6 or 11 months. The eHealthInsurance website will only display what can be sold in your area. For example, if I enter a Houston zip code it will display 12 month plans but if I enter a SC zip code it displays 11 month plans. So, in SC you could use an ACA plan during January and move to a ST plan the remainder of the year.
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Old 04-09-2016, 07:35 AM   #135
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UHC will not offer exchange plans in Georgia and Arkansas in 2017. They have until May 11th to decide on participation in other states.

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Its withdrawals aren't likely to materially reduce competition in those states; four other carriers are staying on in Arkansas, and eight in Georgia. Whether United will withdraw from other states where it sold plans in 2016 is still unknown, as the last deadline nationwide for submitting proposals for 2017 plans isn't until May 11.

Here's how small a factor United has been:

In Georgia in 2015, United had 9,933 HMO enrollees, or a market share of 4.47%. UnitedHealthcare Life Insurance had another 825 members. The big players were Aetna, Anthem Blue Cross Blue Shield, and Humana, which had more than 200,000 customers, or more than 90% of the market, altogether. United, which hadn't even joined the Georgia ACA market until 2015, had sought a rate increase of 18.64% for 2016, but had to settle for 13.2%. Georgia was one of the states in which United canceled broker commissions for ACA insurance plans, which was a way to reduce its presence in the market even further.

Detailed figures aren't available for Arkansas, but indications are that it was trying to build its book of business from a very small base. The company had offered only off-exchange individual plans in 2015, when it signed up all of 521 customers. The company sought a rate increase of nearly 20% for those customers in 2016, so its competitiveness was probably not very high.
Reference: UnitedHealth starts pulling out of Obamacare, but will anybody notice--or care? - LA Times

Meanwhile, a former UHC CEO is starting a new health insurance company called Bright Health.
Reference: http://www.startribune.com/former-un...lan/374830041/
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Old 04-11-2016, 11:43 AM   #136
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First post.

We came from a decade (actually more) or corporate coverage with UnitedHealth. Paid several hundred a month as payroll deduction(s).

Once ACA online application was processed (easy peasy..) and once I had selected a comparable Silver Plan, was surprised to discover:

1) We pay only 32 / person / month for better coverage with 900 / annual max
2) We have access to all doctors we want to use
3) Even with a need to visit a doctor that insurance would consider "out of network", no big deal, we just inform front desk and they are happy to give us a cash rate, usually 65-120 for an office visit.
4) We have *both* a Subsidy *and* a Cost Reduction/Cost Sharing price reduction for services covered
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Old 04-11-2016, 01:07 PM   #137
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First post....
Is ACA relevant at all in Guam? If I understand correctly Medicare is valid. What about Medicaid or anything resembling it?

Can you tell us more about yourself and you current situation? I am particularly interested in your experience living in both Guam and the continental USA. Is Guam a reasonable destination for a non-military retirement location?

Trying to minimize my thread high jack, may I suggest a new post in the Hi, I am... section.

Welcome aboard!
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Old 04-11-2016, 01:48 PM   #138
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We maintain a primary residence in lower 48. That is also, due to the law, why we use/have the ACA plan and also to comply with US tax regulations.
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Old 04-12-2016, 09:05 AM   #139
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UHC will not offer exchange plans in Georgia and Arkansas in 2017. They have until May 11th to decide on participation in other states.

Reference: UnitedHealth starts pulling out of Obamacare, but will anybody notice--or care? - LA Times

Meanwhile, a former UHC CEO is starting a new health insurance company called Bright Health.
Reference: Ex-UnitedHealth exec to launch new health plan with $80M in funds - StarTribune.com
They just started operating in the Atlanta area with a subsidiary called Harken Health, which is a totally new experiment in managed care. All primary care visits are free and you get the UHC network of docs for everything else.

I thought about switching to them this year (we're with Humana on ACA now) but since they were new to the market, with new clinics etc., I figured I'd give them a year to shake things out. They are cheaper than Humana but we've had good service from Humana so far, perhaps I'll switch next year if Humana goes up substantially.

This is the clinic we would use, good story about Harken. Only drawback is having to switch primary care docs.

http://khn.org/news/unitedhealth-tri...e-health-plan/
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Old 04-16-2016, 07:27 AM   #140
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UHC will not offer exchange plans in Michigan in 2017. This is the third state after Arkansas and Georgia. UHC has filed for an average rate increase of 9.4% in Virginia for 2017.

MI: UnitedHealth to Stop Offering Affordable Care Act Plans in Michigan in 2017 - NASDAQ.com

VA: Virginia health insurers seek double-digit premium increases - Daily Press
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