An actual reporting

[audreyh1]

Quote:

Originally Posted by clifp For me the bronze ACA plan was the best also. I have never spent more than $500 in a year on medical care (beyond premiums) in my life, and while that will undoubtedly change. I don't have clue when it will. The $ saved from the premium I figure will add up to more than modest saving that a silver or gold ACA plan would provide if I got modestly sick.Since the OOP is the same for all plans the bronze is cheaper if you get really ill.. On the other hand my grandfather plan is significantly better than any ACA plan. Is it worth the extra $1,500/year probably not but the sheer hassles of dealing with exchange is making think; screw it, I'll stick with the existing plan. I am curious is there any mechanism to prevent people from starting with a bronze plan and then upgrading to better plan if they develop a chronic condition?

Even with my options, for high medical expense cases, the total cost of bronze plans ended up costing less than $300 more annually compared to a more comprehensive, low-deductible silver plan. So for TX, at least, I'm not seeing the financial incentive to pay higher premiums.

There will be open enrollment every end-of-year period, so people can "upgrade" or switch plans if there is a financial benefit.

But, IMO, you will probably just be trading premiums for expenses in these plans. The lower deductible, lower co-pay plans come with a much higher premium. Especially plans with a lower max OOP. As they probably should.

[audreyh1]

Quote:

Originally Posted by rbmrtn +1 on everything you said. I know a number of folks with no conditions, no prescriptions and rarely use medical services forced into the hi risk pool. You can be rejected for anything and everything they want to use. I wonder if these are the masses of desperately sick they think are going to come crawling to the exchange.

That's what I wonder.

[Mulligan]

Quote:

Originally Posted by audreyh1 That's what I wonder.

After reading various reasons why some people have been rejected, my definition of "unhealthy" must be a lot different than the insurers definition.

[audreyh1]

Quote:

Originally Posted by Mulligan After reading various reasons why some people have been rejected, my definition of "unhealthy" must be a lot different than the insurers definition.

I think so. I have heard so many conditions that seemed so trivial. So many people who had no chronic disease or imminent operation or anything that really that needed treatment.

It was apparently just easier to tell people no.

I wonder in my case, since the insurer also managed the state risk pool, whether they had a motivation to push people into that instead. Who knows how profitable the risk pool may have been for them?

[clifp]

Well that seems like an easily exploited feature, for chronic diseases like diabetes or high blood pressure. Although to be fair people may have been able to upgrade existing policies with the same carriers before ACA.

[audreyh1]

Quote:

Originally Posted by clifp Well that seems like an easily exploited feature, for chronic diseases like diabetes or high blood pressure. Although to be fair people may have been able to upgrade existing policies with the same carriers before ACA.

I see higher premiums with no or little break in the max OOPs for the higher metal plans, so it's not clear to me that the chronically ill folks will really save much by "upgrading".

[modhatter]

Years ago, I had a policy with BCBS. I had it for over 30 yrs. Then one day I was looking in the mirror, and noticed I had these lumps on ea. side of my upper neck just below my ears. Went to doctor who sent me to Oncologist, who scheduled me to have one node removed and biopsied.

Luckily it came back negative. The following year I got a notice from BCBS that my insurance was going from about $300 a month to $600 (rounded figures). I did not know why and they did not explain. Other than this incident, I had never had any claims except regular doctor visits etc. (Yearly check up, pap smears etc.)

The following year I got a notice from them it was going up to $900. I was about to cancel it after trying to get new insurance when I got a letter from them canceling my policy. (called rescission)

I wound up getting a new policy eventually (at a very high cost) but had to agree to an exclusion concerning cancer for six years. I had no choice so I did so. Thirteen years after my biopsy, I came down with Lymphoma. Luckily by then I had just gotten Medicare, so all was covered.

I'm only telling you this story to let you know what thin ice you can be on when you have an individual policy. That is why I am so thankful for the new laws interacted within the ACA. I am protected now because I have Medicare, but I still fretted for all those like me before ACA.

No one imagines this could happen to them. But if you hint of any kind of serious expensive illness, it could have been you too.

So if you are among those whose premium went up with the new ACA plan, I would say try and accept it because you don't know how much more you are really getting.

[rbmrtn]

Quote:

Originally Posted by modhatter I'm only telling you this story to let you know what thin ice you can be on when you have an individual policy. That is why I am so thankful for the new laws interacted within the ACA. I am protected now because I have Medicare, but I still fretted for all those like me before ACA.

Yes, all too common. You never really know if you have insurance until you try and use it.

[donheff]

I watched my nephew go thru a horror story like that Modhatter which is why I am a fan of the ACA. It is a seriously flawed law (I would prefer a single payer system covering all of us) but it is leagues above the capricious system we have been living with.

[Mulligan]

Quote:

Originally Posted by modhatter Years ago, I had a policy with BCBS. I had it for over 30 yrs. Then one day I was looking in the mirror, and noticed I had these lumps on ea. side of my upper neck just below my ears. Went to doctor who sent me to Oncologist, who scheduled me to have one node removed and biopsied. Luckily it came back negative. The following year I got a notice from BCBS that my insurance was going from about $300 a month to $600 (rounded figures). I did not know why and they did not explain. Other than this incident, I had never had any claims except regular doctor visits etc. (Yearly check up, pap smears etc.) The following year I got a notice from them it was going up to $900. I was about to cancel it after trying to get new insurance when I got a letter from them canceling my policy. (called rescission) I wound up getting a new policy eventually (at a very high cost) but had to agree to an exclusion concerning cancer for six years. I had no choice so I did so. Thirteen years after my biopsy, I came down with Lymphoma. Luckily by then I had just gotten Medicare, so all was covered. I'm only telling you this story to let you know what thin ice you can be on when you have an individual policy. That is why I am so thankful for the new laws interacted within the ACA. I am protected now because I have Medicare, but I still fretted for all those like me before ACA. No one imagines this could happen to them. But if you hint of any kind of serious expensive illness, it could have been you too. So if you are among those whose premium went up with the new ACA plan, I would say try and accept it because you don't know how much more you are really getting.

What a horrible experience Mod! I have never had a health issue to file a claim, but I have heard terrible stories like yours. I am curious as from what I understood even though you were in an individual policy, you are actually assigned to some type of subgroup in it. I was under the impression they could only raise your rates in the same manner as everyone else in your "group". And if you got cancelled, everyone else in that group,got cancelled also. Is that your understanding? Was your whole "group" cancelled or you individually? My terminology isn't strong, but I thought the rescission term was used individually because the insurer claimed a person lied on their health disclosure. Seems like 30 years would exempt you from that. I guess many of these companies just did what the heck they wanted to do to protect themselves instead of the customer. Of course each state may have different rules for these things.

[modhatter]

Quote:

Originally Posted by Mulligan What a horrible experience Mod! I have never had a health issue to file a claim, but I have heard terrible stories like yours. I am curious as from what I understood even though you were in an individual policy, you are actually assigned to some type of subgroup in it. I was under the impression they could only raise your rates in the same manner as everyone else in your "group". And if you got cancelled, everyone else in that group,got cancelled also. Is that your understanding? Was your whole "group" cancelled or you individually? My terminology isn't strong, but I thought the rescission term was used individually because the insurer claimed a person lied on their health disclosure. Seems like 30 years would exempt you from that. I guess many of these companies just did what the heck they wanted to do to protect themselves instead of the customer. Of course each state may have different rules for these things.

I had a PPO type policy at that time. I don't know how it was structured to tell you the truth. But when I was trying to get insurance again I contacted an insurance broker who told me it would be safer in my case to try and get an HMO, as with HMO's they can't do that. You are essentially part of a group and it would be more unlikely they could single me out.

Yes, today I hear that to cancel you, they generally have to come up with some kind of silly reason like you say. But in my case they didn't. In fact I repeatedly called them to ask them why but my calls were more when they jacked up my rates so high. But as I recall, I was just passed around and no one would help or really answer questions.

I don't know if at the time they were allowed to do that or not. When they tripled my premium I had all ready decided I needed to find another insurance company (not knowing what laid ahead), but before I could do it, they cancelled the policy. Knowing what I know now, I would have challenge them if I knew it was not legal at the time. But at the time I was not aware of these kind of insurance practices.

Here's a great interview I saw that explains a lot about how insurance companies work.
http://www.pbs.org/moyers/journal/07102009/watch2.html