BEFORE ACA - what did retirees do?

[agh1]

Quote:

Originally Posted by johnhkc Before ACA, any pre-ex exclusion could only last 18 months under federal law. Starting in the 19th month of your new plan, the condition is no longer considered pre-ex. However, the rate could still be much higher. You could do COBRA and an HSA plan at the same time then once COBRA expires, use your HSA/HDHP plan.

Are you speaking of employer insurance? Because in the individual market you just could not buy the insurance at all.

Also, I only had an HSA option for 6 weeks of my employment followed by 18 months of Cobra. ACA does not offer HSA here.

[ziggy29]

Quote:

Originally Posted by agh1 Are you speaking of employer insurance? Because in the individual market you just could not buy the insurance at all.

Well, under the old rules (HIPAA, AKA Kennedy-Kassebaum), in most cases it did not specifically guarantee it for individual plans unless you were an "eligible individual". To be an eligible individual, you would have had to have at least 18 months of prior creditable group coverage with a gap of less than 63 days (and had to exhaust COBRA). In many states that defaults to the state risk pool.

It also did not guarantee that individual coverage, even for eligible individuals, would be remotely affordable, just that it would have to be made available -- and for many folks, 18 months of COBRA would definitely not be affordable. ACA has currently made this a moot point, but if it is ever dismantled, these provisions of Kennedy-Kassebaum were never explicitly repealed and are still on the books.

https://www.kff.org/other/state-indi...2:%22asc%22%7D

[johnhkc]

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Originally Posted by NW-Bound Golden Rule was our private HI, as described in earlier post. Starting out healthy with no problem whatsoever, I ended up costing them $200K+ in 2013-2014 with my illness. I never had any problem with them regarding the claims. Never had to talk with anybody there. On the Web, I later found out that healthcare providers liked Golden Rule because they paid promptly. ... PS. I like the Golden Rule policy I had. Very simple. Until I reached $10K/year, I paid everything. Above it, they paid everything. No copay. All or nothing.

That's the plan I still have. In Missouri, the HSA plans are guaranteed renew. Under federal law, all HSA plans must have the same premium for everyone of the same age (i.e. group rates). So I get individual ownership at group rates, guaranteed renew, low premiums (grandfathered under ACA) and tax deductibility (I "work" at my own LLC). At age 51, premium after tax incentives is approx $210 per month, $5K deductible.

At age 39 when I started, premiums were $89.28 per month minus HSA deduction minus tax deduction for premiums = -$22 per month!

[agh1]

Quote:

Originally Posted by ziggy29 Well, under the old rules (HIPAA, AKA Kennedy-Kassebaum), in most cases it did not specifically guarantee it for individual plans unless you were an "eligible individual". To be an eligible individual, you would have had to have at least 18 months of prior creditable group coverage with a gap of less than 63 days (and had to exhaust COBRA). In many states that defaults to the state risk pool. It also did not guarantee that individual coverage, even for eligible individuals, would be remotely affordable, just that it would have to be made available. ACA has currently made this a moot point, but if it is ever dismantled, these provisions of Kennedy-Kassebaum were never explicitly repealed and are still on the books. https://www.kff.org/other/state-indi...2:%22asc%22%7D

I did not have a gap but I was required to provide full medical history going back almost 20 years in order to get the individual plan. In that time one of my doctors had passed away. The insurance company said I had to find the records. I could not. Even the building where his office had been was no longer there. During all this back and forth the wait time for insurance on the new job passed so I just went with that. It may be that they had to offer you the coverage but they could do underwriting to set the price. Pre-existing conditions could make that price too high for many/most people to pay.

[johnhkc]

Quote:

Originally Posted by agh1 Are you speaking of employer insurance? Because in the individual market you just could not buy the insurance at all. Also, I only had an HSA option for 6 weeks of my employment followed by 18 months of Cobra. ACA does not offer HSA here.

HSA plans are not individual market - they're all grou p market. Under federal law, in order to be HSA-compliant, all people within a state are in the same group. (If not the state, then within the same ratings area.)

I researched all of this crap before I retired in 2008 but my focus was on HSA plans so I don't know anything about all the other plan types.

[agh1]

Quote:

Originally Posted by ziggy29 ... for many folks, 18 months of COBRA would definitely not be affordable. ACA has currently made this a moot point, but if it is ever dismantled, these provisions of Kennedy-Kassebaum were never explicitly repealed and are still on the books.

At my age, 60+, and in my county, good Cobra robust wide network PPO coverage is less than 1/2 the cost of the cheapest ACA narrow network HMO bronze plan. For the younger crowd, ACA is cheaper but coverage is not as robust.

[ziggy29]

Quote:

Originally Posted by agh1 At my age, 60+, and in my county, good Cobra robust wide network PPO coverage is less than 1/2 the cost of the cheapest ACA narrow network HMO bronze plan. For the younger crowd, ACA is cheaper but coverage is not as robust.

Yes, I can believe that if you are in a group with a pool of mostly younger workers, since employer group coverage usually does not base premiums on age whereas ACA-compliant individual plans do.

[johnhkc]

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Originally Posted by MichaelB They submitted cert petitions for SCOTUS to hear the case. They still need the process to be expedited, otherwise it falls outside of the current term. I’m not an attorney and have no idea whether the Supreme Court will agree there is a compelling need to see the case now. A good overview of the process can be seen here https://www.healthaffairs.org/do/10....6.206114/full/ If that were to happen, and the lower court ruling upheld, there would be nothing to replace the ACA. Insurers would be free to do pretty much as they wished unless new regulations are passed.

From Politico: "SUPREME COURT WANTS TRUMP's DOJ, RED STATES TO WEIGH IN ON ACA LAWSUIT REQUEST — The high court Monday afternoon asked the Trump administration and Republican-led states challenging Obamacare to quickly respond to the request from Democratic attorneys general to fast track the case, POLITICO's Susannah Luthi reports."

[agh1]

Quote:

Originally Posted by ziggy29 Yes, I can believe that if you are in a group with a pool of mostly younger workers, since employer group coverage usually does not base premiums on age whereas ACA-compliant individual plans do.

A group can have bad rates with younger employees as well. Sometimes young employees have very sick children as an example. The smaller the company the bigger the impact on premiums.

[johnhkc]

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Originally Posted by W2R Right! Bingo. You are understanding exactly what I was saying. That was why I didn't take the higher paying, more prestigious, more intellectually challenging job (in the private sector) that was my other option.

This is why I wanted the HSA. It was a major reason why I decided to retire at 39. Since it's group rates and individually owned, I can hop from job to job (if any) without any disruption in health insurance. I can quit, I can be fired, layed off, play video games for 19 months (fun!) or whatever. It has no effect on health insurance. I just have to have the $ to pay the (lower) premiums. All of these employment-tied plans cause so many problems that way.

[johnhkc]

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Originally Posted by NoMoreJob Our experience very closely mirrors pb4uski's. What we didn't have with private insurance prior to the ACA was coverage for pre-existing conditions. We didn't have any but once a condition popped up I assume that starting with the next year's coverage the condition could have been non-covered. If I'm correct, this was a big risk we lived with at the time that we do not live with now (actually just my wife since I am not on Medicare). On the other hand, our area's ACA policies now only offer local networks of doctors which exclude the better doctors and clinics. So we are better off in terms of pre-existing conditions but worse off in terms of quality of health care available to us as well as cost of coverage and deductibles.

Before ACA, pre-ex only triggers when you (1) have a medical condition and (2) switch insurance company/plan. As long as you renew your plan, pre-ex stuff is not triggered.
When you first sign up, yes - but after that, no.

Pre-ex exclusions were part of federal law before ACA. These laws were enacted to dissuade people from buying into insurance at the last minute. The idea was that since you can't predict when you'll need it, you should buy now and keep buying it. With an 18-month exclusion window, you won't be able to "predict" when you'll need insurance. If everyone "predicted" this way, there wouldn't be any insurance because there wouldn't be any healthy people to pay for the unhealthy ones.

The same way that the individual mandate was a law to bring people into the pool. Pre-ex laws attempted to do the same.

[johnhkc]

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Originally Posted by LimaPop I've been using sharing since the mid 1990's, it has worked well for me and my family.

Have you been with the same plan all along? I have CHM Gold. Would you mind telling me which plan you have?

[NoMoreJob]

Quote:

Originally Posted by johnhkc Before ACA, pre-ex only triggers when you (1) have a medical condition and (2) switch insurance company/plan. As long as you renew your plan, pre-ex stuff is not triggered. When you first sign up, yes - but after that, no. Pre-ex exclusions were part of federal law before ACA. These laws were enacted to dissuade people from buying into insurance at the last minute. The idea was that since you can't predict when you'll need it, you should buy now and keep buying it. With an 18-month exclusion window, you won't be able to "predict" when you'll need insurance. If everyone "predicted" this way, there wouldn't be any insurance because there wouldn't be any healthy people to pay for the unhealthy ones. The same way that the individual mandate was a law to bring people into the pool. Pre-ex laws attempted to do the same.

But prior to ACA couldn't the insurance company drop you and if that happened then you would have to on a new plan likely subject to underwriting and with any pre-existing condition excluded?

[johnhkc]

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Originally Posted by NoMoreJob But prior to ACA couldn't the insurance company drop you and if that happened then you would have to on a new plan likely subject to underwriting and with any pre-existing condition excluded?

Not with HSA plans - they're all guaranteed renew. In order to be HSA compliant, they had to be guaranteed renewable and group rated. As long as you pay the premium, you're covered. And the premium is group rated so your individual situation won't cause your rates to skyrocket.

[NoMoreJob]

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Originally Posted by johnhkc Not with HSA plans - they're all guaranteed renew. In order to be HSA compliant, they had to be guaranteed renewable and group rated. As long as you pay the premium, you're covered. And the premium is group rated so your individual situation won't cause your rates to skyrocket.

I and my wife have had HSA plans through the Federal Marketplace that have been cancelled - or at least the plan was no longer offered so we were forced to purchase new plans. Maybe the rule you're referring to is specific to your state?

[daylatedollarshort]

The Kaiser Foundation has a good article on what kinds of conditions were deemed pre-existing conditions and what we might go back to if all or key parts of the ACA are invalidated:

"The impending decision by the Fifth Circuit Court of Appeals in the Texas v. Azar case raises the prospect that insurers will once again be able to return to using people’s health status in determining their eligibility and premiums for health insurance, at least for coverage obtained from the non-group, or individual insurance, market. In the case, the plaintiff states’ Attorneys General and the Trump Administration are arguing that the Affordable Care Act is unconstitutionally structured and should be invalidated in its entirety. This would include overturning provisions that guarantee that people with pre-existing health conditions cannot be denied coverage or charged higher premiums due to their health status....we estimate that 27% of nonelderly adults have a declinable health condition, which is about 53.8 million people in 2018. We further estimate that 45% of nonelderly families have at least one nonelderly adult member with a declinable health condition. ....People with pre-existing health conditions were often denied coverage or charged higher premiums for individual market coverage before the ACA took effect in 2014."

https://www.kff.org/health-reform/is...-and-families/

[GenXguy]

Quote:

Originally Posted by johnhkc From Politico: "SUPREME COURT WANTS TRUMP's DOJ, RED STATES TO WEIGH IN ON ACA LAWSUIT REQUEST — The high court Monday afternoon asked the Trump administration and Republican-led states challenging Obamacare to quickly respond to the request from Democratic attorneys general to fast track the case, POLITICO's Susannah Luthi reports."

That's old news. There's already been a response from both. See my earlier post in this thread:

http://www.early-retirement.org/foru...ml#post2354629

And new news today, the insurance lobby filed a brief with the Supreme Court to take up a case and to rule to uphold the health law.

https://thehill.com/policy/healthcar...old-health-law

https://www.ahip.org/wp-content/uplo...9-841_AHIP.pdf

[explanade]

Before the ACA, there were a lot of stories about rescission.

Insurers collected your premium payments for years.

When some people tried to use their coverage, they discovered that the insurers find you had a pre-existing condition that you didn't disclose, so therefore, no coverage.

[johnhkc]

Quote:

Originally Posted by NoMoreJob I and my wife have had HSA plans through the Federal Marketplace that have been cancelled - or at least the plan was no longer offered so we were forced to purchase new plans. Maybe the rule you're referring to is specific to your state?

All of my research was before ACA so I don't know about the "new" ACA-compliant HSAs. Isn't "federal marketplace" an ACA thing?

I do know that in KC, Blue Cross Blue Shield was a big proponent of ObamaCare and when it was passed, they ended their old plans to push people onto ACA plans. The new premiums were typically around 125% to 150% higher in the first year than what existed before. These were small group/small employer plans. ACA did not FORCE them to terminate these plans - the company chose to. (I worked a short contract there - I saw some interesting stuff.)

Also in that year, people who had Golden Rule (UHC) plans called the company so many times that Golden Rule sent out a letter stating that they had no plans to cancel their grandfathered plans. I still have their PPO plan.

Maybe Missouri has some tight grip on insurance regulation but if they do that's about the only thing they have a tight grip on! Everything else here seems very laid back and loosey-goosey.

[explanade]

ACA raised requirements for what must be covered and eliminated things like lifetime caps and of course didn't allow insurance companies to exclude pre-existing conditions.

These requirements of course made coverage more expensive.

Now some are arguing that insurance policies which aren't comprehensive should be sold as well.

I believe they have been selling such policies the last couple of years but no word on how many enrollments they've gotten.