Applying for ACA 2017 Coverage

[MichaelB]

This is a real conundrum.

It is. This range of difference in price - 2x or more, is common, but so far it has appeared to be the result of provider network design. The the smaller, restricted networks enabling the lower premium policy while the broad scale, nation-wide networks charging the highest premium. In the case of Az it looks like the high price only gets a restricted HMO network.

The insurers are still in Az, selling Medicare, Managed Medicaid, and large group, and prices there do not seem to be unstable, so something else is the cause. A lack of transparency and public scrutiny makes it difficult to understand exactly what is happening, so we are left with the statements made by the insurers.

Look for it to start happening everywhere.

It is definitely not happening in other important insurance markets such as NY, FL and Cal. Another possibility is the underserved states approach the individual market differently and improve health insurance coverage.

 

[NW-Bound]

Again, insurers have to pay out 85% of what they take in. I do not know about their operating cost, but the government spends 10% for administration costs of Medicaid. If the insurers operate the same, that leaves them with 5% profit if they plan it right.

If they make too much money, they have to give it back. It's the law. If they lose money, hey tough luck.

One cannot blame the insurers for not wanting to lose money year after year. What I want to know is the details of how they lost money relative to their anticipated actuarial budget. If it is something in the air here, or the water we drink, I want to know so I can go out of state, heading NW. See my screen name.

 

[MichaelB]

Again, insurers have to pay out 85% of what they take in. I do not know about their operating cost, but the government spends 10% for administration costs of Medicaid. If the insurers operate the same, that leaves them with 5% profit if they plan it right.

One cannot blame the insurers for not wanting to lose money year after year. What I want to know is the details of how they lost money relative to their anticipated actuarial budget.

Insurers are not losing money. They're making bundles of it - in the Medicare, Medicaid and Group markets, with much less pricing volatility and much more competition.

 

[NW-Bound]

Well, I do not know much about Medicare, but that has the government backing. Maybe it is a deal where they cannot lose, and are guaranteed a small but certain profit.

ACA insurance may be more like home insurance. And some places are somehow sickly, but we do not know how yet. For comparison, places prone to have hurricanes like the Gulf coast states are well known, and insurers know how to price the premium correctly.

 

[ivinsfan]

It is. This range of difference in price - 2x or more, is common, but so far it has appeared to be the result of provider network design. The the smaller, restricted networks enabling the lower premium policy while the broad scale, nation-wide networks charging the highest premium. In the case of Az it looks like the high price only gets a restricted HMO network.

The insurers are still in Az, selling Medicare, Managed Medicaid, and large group, and prices there do not seem to be unstable, so something else is the cause. A lack of transparency and public scrutiny makes it difficult to understand exactly what is happening, so we are left with the statements made by the insurers.

It is definitely not happening in other important insurance markets such as NY, FL and Cal. Another possibility is the underserved states approach the individual market differently and improve health insurance coverage.

Exactly i in the exchange and off exchange market for private plans, this is exactly what BCBS has pulled off, cancelled all the PPO plans, moved to HMO and raised the premiums as much as 50%...once other insurers see the move in this direction expect a stampede...BCBS is insuring the same people who they said were causing them to lose 100's of millions of dollars in the last 2 years. Now the people have all been HMO'd.. ( is that a new verb). Blue Cross is open to taking every single one of them back in the HMO format.

 

[MichaelB]

ACA insurance may be more like home insurance. And some places are somehow sickly, but we do not know how yet. For comparison, places prone to have hurricanes like the Gulf coast states are well known, and insurers know how to price the premium correctly.

The insurance markets that cover around 90% of the population do not have these issues. They are expensive, but insurers are not dropping coverage, pricing is much more stable, and there is an abundance of consumer choices. They do share some common characteristics. Everyone is covered, everyone gets some subsidy, and there is only one price for each policy.

The individual market was composed of all those excluded from other insurance, it is much more heavily segmented, pricing is by age and participation is voluntary with a fine for opting out. The price is very high. Insurers are allowed to offer policies to some (direct) and not others (exchange). Trying to understand the mechanics of price differences between states and counties is difficult because the only real common element (among users of the individual market) is that most of them didn't have insurance prior to 2014.

 

[ivinsfan]

The insurance markets that cover around 90% of the population do not have these issues. They are expensive, but insurers are not dropping coverage, pricing is much more stable, and there is an abundance of consumer choices. They do share some common characteristics. Everyone is covered, everyone gets some subsidy, and there is only one price for each policy.

The individual market was composed of all those excluded from other insurance, it is much more heavily segmented, pricing is by age and participation is voluntary with a fine for opting out. The price is very high. Insurers are allowed to offer policies to some (direct) and not others (exchange). Trying to understand the mechanics of price differences between states and counties is difficult because the only real common element (among users of the individual market) is that most of them didn't have insurance prior to 2014.

Prices are rising in the group markets too, I don't know that I would label them "stable" as for choice, your choice is what you employer offers, which might not be much choice at all.I'm a little confused about your subsidy for everyone comment, do you mean thru the employer in fact one could argue that comes directly out of your wage one way or another. And many self employed and people who didn't qualify for insurance thru work had individ. polices well before 2014. I don't if your use of the word most is accurate. In fact going back to BCBS they said there problem in 2014 started when they "drastically underpriced" their exchange policy. A cynical person might say this was part of a long range plan to get to where they are today with only HMO coverage for individuals

 

[NW-Bound]

...Trying to understand the mechanics of price differences between states and counties is difficult because the only real common element (among users of the individual market) is that most of them didn't have insurance prior to 2014.

... and some of them apparently are sicker than others (or just more costly to treat).

As I mentioned in an earlier post, just because a rural county has lower per-capita income and more people on food stamp than a larger, more populous, wealthier county does not mean that the former would cost more in medical care. Or is it that the latter knows all about the fancy-schmancy expensive treatments, and demands them, while the other does not?

When a dozen of insurers cried "Uncle" and fled a market because they all lost money, one has to wonder. And it is stranger still when the premium is allowed to be more than doubled, and they still shook their head and said "Count me out".

Only one insurer, a new kid on the block, steps up to the challenge. Maybe he does not know what he is getting into. I am already dying to see what happens next year.

 

[candrew]

Good news is that even though we have only one option here 6 of GF's 7 Dr's are on the plan.

We live in NW Peoria are newly ER'd (my last day of work is this Friday!). 2017 will be our first foray into the ACA. Pleasantly surprised that with only a single insurer, we'll be keeping all of our current providers. And with the subsidies we qualify for, premiums are relatively reasonable.

 

[ShokWaveRider]

All Seems to be working great today. Healthcare.gov that is. we have too many options to list. Simply going to choose the cheapest Silver Plan. It seems to cover all we will need. Zero Deductible.

 

[RockyMtn]

None has my current PCP in the provider list. I thought the database is not up-to-date, but it looks like it is.

Might want to check the provider list again today. HealthNet added 5 hospitals and about 220 Dr's within a 20 mile radius of my Az home since yesterday!

 

[audreyh1]

My two main doctors are still in network with BCBS HMO Plus.

But the premiums are way higher than last year. Last year premiums would have dropped as BCBSTX dropped their PPO and switched everyone to HMO. We switched to Humana to keep in a PPO, and paid a large price increase for the privilege.

2017 BCBSTX HMO prices are a jump up from the 2016 Humana PPO prices!!! Ouch!

 

[ziggy29]

All Seems to be working great today. Healthcare.gov that is. we have too many options to list. Simply going to choose the cheapest Silver Plan. It seems to cover all we will need. Zero Deductible.

Too many options to list? Must be nice. In my zip code in relatively rural southeast Texas, BCBS has been the only player on the exchange since Day One. And starting this year they no longer had a PPO option. I'm grateful I found a part time j*b with great (and cheap) health insurance. It kinda sucks that I have to go back to work for it, but with the state of health insurance in the country today, working 20 hours a week, give or take, for good coverage for almost no premium cost seems like a no-brainer, especially since I'm still only 51. The thought of dealing with the dysfunctional individual insurance market until we're on Medicare is very unappetizing.

 

[audreyh1]

BCBSTX seems to be the only option in the Valley now. Ehealth did not list any other company for my zip.

 

[NW-Bound]

...I'm still only 51. The thought of dealing with the dysfunctional individual insurance market until we're on Medicare is very unappetizing.

Who's to say that when you get to 65, Medicare will be as it is now?

 

[audreyh1]

I just looked at the 2017 BCBSTX offerings compared to 2016 quotes I saved from last year, and I'm seeing a 64% increase in premiums for only one year older. WOW!

Blue Advantage Plus Bronze... was $389.97 per month, now quoted $642.58! Higher deductible, higher copays too.

Interesting when BCBSTX dropped their PPOs last year, they said they couldn't raise the prices high enough to cover losses because it would require them to raise prices all their other plans (referring to the group plans, one assumes). But that doesn't seem to be a problem this year!!

 

[2017ish]

Insurers are not losing money. They're making bundles of it - in the Medicare, Medicaid and Group markets, with much less pricing volatility and much more competition.

Right. So wouldn't it be imprudent and a breach of their duties to shareholders if they stay in the ACA market? (Of course, BCBS has no shareholders, but it is also exited much of TN and other states....)

 

[reubenray]

I reckecked again and my wife's ACA plan went from $151 to $205 for 2017. This was good to us being her cost jumped to $320 in October after I started getting Medicare. This is for the exact BCBSAL Silver Multi-State plan. The cost for some items on 2017 are less also. One difference was the doctor visit dropped to $30 per visit from $40.

 

[scrabbler1]

Although I can't sign into my state's (New York) exchange website (NY Marketplace) to check out all the rates for 2017 plans and enter income data for subsidy calculations until November 15th, I know a few things already about my own insurer, OSCAR. First, the monthly rate will rise about 9%, to $483 per month (base rate, excluding subsidy which won't be much). Second, I will have some small copays which didn't exist before. Third, several of my doctors will be out of their network, mainly one (as I have written about in another thread) specialist, my endocrinologist for my diabetes. All in all, I'll be in pretty good shape.


I hope I can get into the NY website in those first few days because I'd like to know my options before I visit my endocrinologist on the 18th.

 

[MichaelB]

Interesting when BCBSTX dropped their PPOs last year, they said they couldn't raise the prices high enough to cover losses because it would require them to raise prices all their other plans (referring to the group plans, one assumes). But that doesn't seem to be a problem this year!!

Agree. It's unfortunate that we can't get a look into the details to see what really is happening. In aggregate, though, the insurers appear to have done very well for themselves, while keeping the focus elsewhere.

 

[NW-Bound]

We still cannot blame the insurers, because they cannot be expected to be saints. The government can charge more in one market to subsidize another. Private enterprises cannot afford to do so.

 

[MichaelB]

We still cannot blame the insurers, because they cannot be expected to be saints. The government can charge more in one market to subsidize another. Private enterprises cannot afford to do so.

We're getting badly off topic, but if we need to assign blame, there's plenty to go around, and the insurers have earned their fair share. They have placed themselves as intermediaries in-between consumers and providers of health care, extracting from both, making it impossible for consumers and providers to engage and deal directly. In that case, the insurers must make sure the process works smoothly.

 

[REWahoo]

Save some blame for state insurance regulators who, in some states, approved rate increases higher than insurance companies requested:

In eight states, regulators approved premiums that were a percentage point or more higher than carriers wanted... As of Tuesday, those states are Arizona, Pennsylvania, Colorado, Florida, Georgia, Kansas, Minnesota and Utah.

Regulators approve higher health premiums to strengthen Obamacare insurers

 

[NW-Bound]

Yes, I saw that.

Well, it is not surprising because when you have only one left of anything, you take care of it really well for fear of losing it too.

 

[ShokWaveRider]

We still cannot blame the insurers, because they cannot be expected to be saints. The government can charge more in one market to subsidize another. Private enterprises cannot afford to do so.

My nephew works for a health insurance company. They do purposely limit plans on ACA, and limit doctors on them etc. BUT they offer the same plans that are on the ACA at the same cost outside of it.

Sorry, it is off topic, but I had to respond with actual information from a HCI employee.