Preview 2017 ACA plans now active

[ivinsfan]

All plans must provide emergency care coverage, even if the provider is out of network. The policy holder is still subject to balance billing, which means the policy holder is still liable for excess charges not covered by the plan. In addition, the ER service must meet the insurer's requirements for coverage.

Any care that is "non-emergency" must be in-network and meet all other eligibility criteria. For health insurance, it is critical to understand the insurer's network of providers.

So in "insurance talk" this means for an emergency you can go out of network, but your carrier will only pay the "usual and customary" price they use for your HMO..so you might have a bill of 100K and your insurance might pay 10...there is no "knockdown price" for out of network and you are possibly on the hook for 90K...to the poster that RV'd and wanted to save 5K, this might be your future. Am I understanding this correctly?

 

[ShokWaveRider]

Just got the official 2017 update from Florida Blue today. If we stick with the current plan. It is $40pm more than last/this year. If we change plans which only seems to limit/change GP doctor it goes DOWN $250pm to <$150pm AFTER Subs. 15 minutes to find another doc for that seems like a great deal. Also MOOP goes down and Deductible will be Zero Plan name is 1456B. Emerg. Room $100, Gen. Pres. $5, Doc. Visit $2, Spec. Visit $15.

 

[Options]

For those in California:

Reduce Your Obamacare Sticker Shock | California Healthline

Today, I’m going to pass along five pieces of advice for those of you with Covered California or open market health plans. Open enrollment for those plans begins Nov. 1 and ends Jan. 31, 2017.

But I’m sorry to say that minimizing the damage probably won’t be painless. In order to avoid the biggest rate hikes — and perhaps even see your premiums drop — you may need to make difficult choices: Are you willing to change plans, and perhaps lose your beloved doctor? Would you switch from a PPO to a more restrictive HMO?

“Every year, the story’s always been to shop around. This year, it will be especially important,” says Dena Mendelsohn, a staff attorney at Consumers Union who specializes in health care.

 

[eta2020]

I don't think you understand how bankruptcy really works. You get to keep very little. What you have gets distributed to the people you owe money to, including that doctor.

My FIRE plan doesn't work well if I go bankrupt. That would keep me from having a great big smile.

Well with some planning you could keep pretty much everything even if everything is 8 digit number.

IE live in Florida so house is protected. Roll all brokerage accounts into irrevocable Trust. If in FL annuities are also protected. 401k is protected as well.

But you have to all things in place before having event that leads to bankruptcy. Planning for unexpected is probably not a bad idea.

 

[Refresher]

Well with some planning you could keep pretty much everything even if everything is 8 digit number.

IE live in Florida so house is protected. Roll all brokerage accounts into irrevocable Trust. If in FL annuities are also protected. 401k is protected as well.

But you have to all things in place before having event that leads to bankruptcy. Planning for unexpected is probably not a bad idea.

Not to get off topic but I understand under Florida law all non exempt assets can be used to buy a homestead even after the debts are occurred.

 

[eta2020]

It would show us where the money goes, and what we get in return. It does not solve the problem, but helps us define it.

Maybe after understanding the benefits, we will all say "it's really worth it", and become willing to spend all our own assets (not somebody else's, mind you) down to zero to get "it". But we do not really know what "it" is that costs so much.

Right now, in my area, the health insurance has gone up to more than double in just one year. Per law, insurers have to pay most of it out and not to keep it as profits. So, am I correct in saying that the healthcare cost has doubled? I assume that auditing has been done to see that insurers did not cheat on their books.

What has doubled then? Hospitals have racked up their rates to double? Drugs now cost twice as much? People are now twice as sick?

What is it? Nobody does anything. Just let Uncle Sam keep on paying. He can print more money.

It is simple. In every Advanced economy except USA healthcare is tightly regulated by governments. Government provides it just like it provides Defense, Retirements, Highway infrastructure, Courts, Police or public utilities.

And like it or not they all outperform US system at fraction of cost. Now sure if you are King of Saudi Arabia and you can afford Mayo Clinic this is where you will go.

http://time.com/2888403/u-s-health-care-ranked-worst-in-the-developed-world/

 

[socca]

All plans must provide emergency care coverage, even if the provider is out of network. The policy holder is still subject to balance billing, which means the policy holder is still liable for excess charges not covered by the plan.

Not in all states - Florida enacted a law in 2016 that appears to eliminate balance billing. Here is the link: Florida implements law protecting consumers from surprise medical bills

The practical effect is that medical providers and insurers get to haggle over unpaid bills, while the hapless consumer/victim stays out of the loop - hooray!

 

[NW-Bound]

It is simple. In every Advanced economy except USA healthcare is tightly regulated by governments. Government provides it just like it provides Defense, Retirements, Highway infrastructure, Courts, Police or public utilities.

And like it or not they all outperform US system at fraction of cost. Now sure if you are King of Saudi Arabia and you can afford Mayo Clinic this is where you will go.

Survey Ranks the U.S. Health Care System Lowest in Performance

It is never simple when spending of public money is involved, whether healthcare, defense, or public projects. See my PM or my earlier posts for an example of how other systems can work.

 

[CardsFan]

OK. This is not an ACA plan, but a retiree plan.

4 years ago, before I retired but when I started my planning, this plan was $350/month for two.

This year, when I retired, it was $921/month.

In 2017 it will be $1243/month. A 35% increase.

Thank you ACA for taking over $10,000/yr out of my retirement spending.

FWIW, I checked on line, and an equivalent ACA plan would be over $2,400/month (unsubsidized), and still about $1,200 with the subsidy, if I chose that path. Unfortunately, If I leave the retiree plan, except for employment, I cannot go back. So I will suck it up for the next 4 years until medicare.

For the record, our retirement budget assumed $15,000/year, so we are still good.

 

[Texas Proud]

OK... an update.... the website gave me BS numbers...

Just got info from my insurance.... so instead of going up 37% like I calculated, it is going up 55%!!!! My cost will go up by more than that... maybe double...


WOW!!!!

 

[reubenray]

If everything is correct my wife's 2017 insurance will be $205 which is $146 less than the $351 cost that went up from $151 when I started medicare.

 

[Sue J]

OK... an update.... the website gave me BS numbers...

Just got info from my insurance.... so instead of going up 37% like I calculated, it is going up 55%!!!! My cost will go up by more than that... maybe double...


WOW!!!!

We just got our letter like that. On ours it assumes that our subsidy remains the same for 2017.

Double check that for your situation. Our subsidy changed, in our favor, because of a change in the SLCSP. Use the preview feature on healthcare.gov to check your actual situation.

Good luck with all this!


Sent from my iPad using Early Retirement Forum

 

[Mulligan]

OK... an update.... the website gave me BS numbers...

Just got info from my insurance.... so instead of going up 37% like I calculated, it is going up 55%!!!! My cost will go up by more than that... maybe double...


WOW!!!!

I need to correct my price also. But I dont think it was website BS, but my ipad... I typed in 52, and it came out $302, dropping $20... Well I go back to review and suddenly its $369 or about $45 more than last year. I think the 52 didnt "stick" and the $302 was just a vanilla average of all premiums of all ages combined as that is what shows when an age is not entered...
Now I got more info today just now interesting...Coventry 2 weeks ago gave me a get lost letter we are dropping from exchanges and go find another plan from someone else. Today, I get a letter from them encouraging me to continue with them through an off exchange plan that they will offer... I will have to check it out...Maybe the past 2 weeks they dug through info on people who only paid and didnt use the insurance and want to keep the "profit people" around... As I do not know any other reason and they clearly could have mentioned that in the previous letter.

 

[socca]

.Coventry 2 weeks ago gave me a get lost letter we are dropping from exchanges and go find another plan from someone else. Today, I get a letter from them encouraging me to continue with them through an off exchange plan that they will offer...

I received the "get lost" letter from Aetna a week ago, and have not (yet) received an off-exchange plan solicitation from them. I assumed that the first letter is boilerplate required by law, and they deliberately avoided mentioning the possibility of off-exchange plans in that letter to avoid enraging the bureaucrats in DC. It will be interesting to see just how much of a discount the off-exchange plans will offer (if any). How does the risk pool consisting of folks who don't collect subsidies differ from the risk pool consisting of those that do? A fascinating question...

 

[travelover]

............OK. This is not an ACA plan, but a retiree plan. .........
Thank you ACA for taking over $10,000/yr out of my retirement spending.
...........

Your costs did not go up because of the ACA, they went up because medical care is rising unchecked, ACA or no ACA

 

[Mulligan]

I received the "get lost" letter from Aetna a week ago, and have not (yet) received an off-exchange plan solicitation from them. I assumed that the first letter is boilerplate required by law, and they deliberately avoided mentioning the possibility of off-exchange plans in that letter to avoid enraging the bureaucrats in DC. It will be interesting to see just how much of a discount the off-exchange plans will offer (if any). How does the risk pool consisting of folks who don't collect subsidies differ from the risk pool consisting of those that do? A fascinating question...

Socca, I havent started digging yet. I suspect the pricing will not be that much different. And excess profits must be returned....But I suspect they would much rather give back and maintain max profits as opposed to being exposed to losses. I have no facts to support this, but common sense indicates there is a reason they drop from exchange and yet will still continue on off exchange. Im sure the bean counters know the subsidized people most use it more because it doesn't cost as much to use it. Or they didnt access healthcare until they have a policy and now have some "repair work to do" or long term issues being treated now.
People who buy off exchange have likely been more healthy to begin with because they have had insurance all along paying for it.

 

[CardsFan]

Your costs did not go up because of the ACA, they went up because medical care is rising unchecked, ACA or no ACA

Seriously??

Health care costs have been rising 6-10% per year for a while. In 4 years the cost of this insurance (with now much higher deductibles) has quadrupled.

Coincedentiality ACA was passed in this time frame. I know correlation is not causation, but this certainly appears related.

I know that companies cap benefits, and that probably makes it worse. But ACA has clearly raised the cost of insurance for those of us that pay "rack rate".

 

[Mulligan]

Socca, I just checked Coventry website for the off exchange plan. Lets just say it aint for the poor people.. Only one plan offered. A very nice robust list of providers and care. The rub... Its $679 and no HSA option. My Veterinary Care provider plan I will sign up for is $369 an HSA deductible which saves me 31% in taxes to fund it. Im not going off exchange as long as I am a subsidizer and not a user. If I had maladies that need a good doctor provided list, I would seriously consider this plan.
I compared it to highest cost Silver plan on exchange and it was a $100 higher..But again, it looks more robust, not gotcha insurance like I am going to buy.

 

[Texas Proud]

We just got our letter like that. On ours it assumes that our subsidy remains the same for 2017.

Double check that for your situation. Our subsidy changed, in our favor, because of a change in the SLCSP. Use the preview feature on healthcare.gov to check your actual situation.

Good luck with all this!


Sent from my iPad using Early Retirement Forum

I did not try and get a subsidy monthly this year.... so this is full rate comparison... I will do so next year, but still think that my net premiums are going to double...

 

[NW-Bound]

Using this as an example of premiums in Az, I compared them with my own zip code. A 30 year old male in Az faces a premium of $421, in South Fl the premium for the same policy (Ambetter Balanced Care 4) would be $256. That is a big difference in price. We know that the MLR requirement limits the total profit, so either the cost of administering the policy is much different, or as R-Bum suggests, in Az there are fewer policyholders that require proportionally more care.

Edit to add - one easy difference between the two locations is S Fl has a much higher population density.

It is not as simple as that. Maricopa County which encompasses Phoenix has a population of 4 million. It may not be as populous as S Florida, but more than many other places.

For example, the map of 2017 premium increases shows that Wyoming does better than AZ. So, I looked at Cheyenne, the capital of Wyoming to see what the cost would be for someone my age. Cheyenne is inside Laramie County, which has a population of 96,000. That's 2.4% the population of Maricopa County. Cheyenne itself has 64,000, the same as a few neighborhoods in Phoenix.

In Cheyenne, a cheapest Bronze plan would be $1665/month for us, instead of $1,892/month in Phoenix.

But as mentioned, the map shows that Wyoming is one of the states with the lowest premium increase for 2017. Does that mean these folks have been paying high premium back in 2016 already, while I have been enjoying low premium relative to elsewhere, and did not know it?

The more I look, the more bewildering the data appears.

By the way, in Los Angeles a cheapest Bronze plan would be $852/month. That's more inline with our premium in 2016.

 

[niven]

It is not as simple as that. Maricopa County which encompasses Phoenix has a population of 4 million. It may not be as populous as S Florida, but more than many other places.

You made me look - Wow, Maricopa county has a population of 4 million and there are only 6.6 million in the entire state of Arizona. So 60% of the population live in that one county. I guess the rest of the state is mostly populated by coyotes, prairie dogs and snakes. I wonder what their healthcare costs are?

 

[eta2020]

It is never simple when spending of public money is involved, whether healthcare, defense, or public projects. See my PM or my earlier posts for an example of how other systems can work.

You must be referring to your post with "diabetic pliers DYI self surgery toes".

Do you know how many ugly articles about US healthcare I can google out? One of the good indicators of "average" healthcare one gets is "average" life expectancy.

https://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy
All developed economies on this list (with higher life expectancy) have better health care at fraction of the US cost. That includes UK from your "diabetic pliers DYI self surgery toes" articles.

 

[MichaelB]

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