Covered California exchange announces preliminary rates

[MichaelB]

Covered California, the state health exchange, has announced rates for 2014.

The announcement is here News Magazine | Style Demo

The rates submitted to Covered California for the 2014 individual market ranged from two percent above to 29 percent below the 2013 average premium for small employer plans in California’s most populous regions. This is impressive since the 2014 products include doctor visits, prescriptions, hospital stays and more essential benefits; protecting consumers from the "gimmicks and gotchas" of many insurance policies.

Consumer guide is here http://www.coveredca.com/news/PDFs/CC_Health_Plans_Booklet.pdf

A comparison of Silver level policpy rates is here http://www.coveredca.com/news/PDFs/SilverPlanRatesChart.pdf

 

[M Paquette]

Well, I'm happy. DD's rate went up by a "huge percentage", or about $60 a month. Rates for DW and I went down a bit percentage-wise, but a much bigger savings dollar-wise than the raised cost for DD. This is pretty much what I expected. Our HMO is slightly more expensive than the rates for the two big non-HMO companies, but the lower 'hassle factor' with the HMO (no in-network vs out of network, electronic records available to our GP and specialists instantly, and overall ease of use) far outweighs the very small pricing difference.

 

[Mulligan]

Well, I'm happy. DD's rate went up by a "huge percentage", or about $60 a month. Rates for DW and I went down a bit percentage-wise, but a much bigger savings dollar-wise than the raised cost for DD. This is pretty much what I expected. Our HMO is slightly more expensive than the rates for the two big non-HMO companies, but the lower 'hassle factor' with the HMO (no in-network vs out of network, electronic records available to our GP and specialists instantly, and overall ease of use) far outweighs the very small pricing difference.

Congratulations M! Good news to hear for you. $60 would be an 80% increase for me, but I would take it in heartbeat an sign the contract cheerfully!

 

[pb4uski]

Rates look very reasonable to me. Are about what I pay now or less.

 

[twolfy]

I have not read up much on the affordable health care plan so I decided to get going by reading this thread. Thanks for starting it by the way. While reading I decided to learn more about the FPL (federal poverty level) as I noticed that rates are detemined as a result of your income %to the FPL. Whie googling FPL and income > and < 400 % I came across an interesting article that talks about the income level traps that are out there. Thought I would pass it along.
Tom
http://www.dailykos.com/story/2012/...-Health-Insurance-Cliff-will-Kick-In-For-Real

 

[scrinch]

Rates seem reasonable to me also...except the rates for a 55-yr-old aren't shown.

So all the plans offer the same (or almost the same) coverage at each bronze, silver, etc level. Does anyone know whether actual charges from providers will be more-or-less the same for the various plans? I.E. Do the different providers have significantly different negotiated rates with hospitals, medical groups, labs, etc? Do you think your overall medical costs if you sign up with one of the big boys (Blue Cross) will be significantly lower since they have more clout to negotiate lower rates with provider groups, or are all the insurance groups likely to have similar provider rate sheets?

 

[Ready]

The cost estimator is showing a monthly estimate for me of $345/month assuming no subsidy. That is less than my former employer used to pay per employee for a large group policy. If these figure are correct that is fantastic news!

 

[explanade]

No sticker shock in CA?

Obamacare in California: No sticker shock here | New Republic

 

[Mulligan]

No sticker shock in CA?

Obamacare in California: No sticker shock here | New Republic

The last paragraph in the article concerns me, where it mentions Texas and Florida as possibly facing higher costs due to hostility towards The Act. My state of MO is following the path of Texas, so it may not be as favorable. Good news for California people though!

 

[fh2000]

Thank you, Michael, for your continuing effort of providing ACA information.

DW and I are not retired yet. Hopefully in 2014. I am in Los Angeles (South) with a family of 4. I am using these ages (58, 52, 2 under 21), and plan to limit my retirement income below $73,000 (15% tax rate). From the Covered California Calculator, I get a monthly premium of $578 ($6,936 annually).

I understand this is based on a Silver plan. The Covered California also estimates the OOP amount as below:
"The benefit plans also feature out-of-pocket maximums: $6,400 for individuals and $12,800 for a family. In other words, if you get very sick or injured, that is the maximum amount you will have to pay outside of your premium."

Our family is blessed with good health and we have not had a large amount of OOP so far.

If $12,800 is the max OOP for a family, I am thinking of using half of that amount as my annual budget. I am interested in knowing how much OOP amount, would members of this forum budget annually participating ACA?

 

[fh2000]

Thank you, Michael, for your continuing effort of providing ACA information.

DW and I are not retired yet. Hopefully in 2014. I am in Los Angeles (South) with a family of 4. I am using these ages (58, 52, 2 under 21), and plan to limit my retirement income below $73,000 (15% tax rate). From the Covered California Calculator, I get a monthly premium of $578 ($6,936 annually).

I understand this is based on a Silver plan. The Covered California also estimates the OOP amount as below:
"The benefit plans also feature out-of-pocket maximums: $6,400 for individuals and $12,800 for a family. In other words, if you get very sick or injured, that is the maximum amount you will have to pay outside of your premium."

Our family is blessed with good health and we have not had a large amount of OOP so far.

If $12,800 is the max OOP for a family, I am thinking of using half of that amount as my annual budget. I am interested in knowing how much OOP amount, would members of this forum budget annually participating ACA?

I can see how my own explanation could be confusing: my health care budget is actually $6,936 + $6,400 (1/2 of OOP max) = $13,000+.

 

[MichaelB]

Fh2000, thanks for the kind words. Many forum members contribute to the body of knowledge we have accumulated here.

In our case we don't budget the total OOP, we do budget the average of what we spent over the past 4 to 5 years in unreimbursed healthcare expenses. At the same time, we carry the entire total OOP amount in our emergency fund, along with other large amounts we are certain to spend over the next 5 years or so.

 

[Mulligan]

I can see how my own explanation could be confusing: my health care budget is actually $6,936 + $6,400 (1/2 of OOP max) = $13,000+.

I am single and have a $5500 deductible. I fully fund my $3000 plus HSA. So, I fund about half the deductible. But I have enough already built in savings to cover the rest as needed, so I do not budget per se for it. I hope I can build a nice amount in my HSA before any illnesses develop.

 

[Disappointed]

Thank you Michael. I am about to lose my health insurance due to a change of ownership of our company, the Obamacare is quite important to me. Also, with my pre-existing condition, I would have been out of luck finding my own coverage.

 

[freebird5825]

For comparison purposes only, NY's approach to ACA compliance.

Health Benefit Exchange - Federal Health Care Reform Implementation in New York State

 

[killingme]

Sorry to sound like a naysayer but color me extremely skeptical. This all sounds good on paper but talk to me a year or two after full implementation, since I am happy with both the cost and quality of my current health care.

Just today there was a news story on the shortage of doctors and the shortages are predicted to get worse. Local legislators are trying to get ahead of it Grimm, Crowley, Reintroduce Legislation to Address Looming Doctor Shortage | Congressman Michael Grimm

My best childhood friend is a Neurosurgeon in CT who has seen a quantum shift of talent away from medicine and has himself abandoned his practice due to onerous regulations, obtuse governmental mandates and falling reimbursement rates. He went so far as to get a law degree (he sees medical malpractice as the next boom industry) stating that in short order med students will be "fast tracked" to get them into practices sooner, lowering the quality of care.

Many of his peers have gone to private practices that will not accept any insurance as concierge doctors which will only make the problem worse. I can only hope that I am wrong.

 

[eridanus]

Just today there was a news story on the shortage of doctors and the shortages are predicted to get worse. Local legislators are trying to get ahead of it Grimm, Crowley, Reintroduce Legislation to Address Looming Doctor Shortage | Congressman Michael Grimm

Because of the aging boomers and the AMA. Wouldn't this happen/hasn't this been happening without Obamacare?

'“Our country needs us to do all we can to alleviate the coming doctor shortage, yet an outdated limit on the number of doctors that can be trained ties the hands of our medical schools and our teaching hospitals,” said Rep. Crowley.'

USATODAY.com - Medical miscalculation creates doctor shortage <=== Ooops

My best childhood friend is a Neurosurgeon in CT who has seen a quantum shift of talent away from medicine and has himself abandoned his practice due to onerous regulations, obtuse governmental mandates and falling reimbursement rates.

My childhood best friend is an anesthesiologist in CA and he's still making a ****-ton of money and he's never complained about onerous regulations. He's also working part-time because he can do so and easily make 6 figures. What's your point again?

 

[Lakewood90712]

Rates seem reasonable to me also...except the rates for a 55-yr-old aren't shown.

So all the plans offer the same (or almost the same) coverage at each bronze, silver, etc level. Does anyone know whether actual charges from providers will be more-or-less the same for the various plans? I.E. Do the different providers have significantly different negotiated rates with hospitals, medical groups, labs, etc? Do you think your overall medical costs if you sign up with one of the big boys (Blue Cross) will be significantly lower since they have more clout to negotiate lower rates with provider groups, or are all the insurance groups likely to have similar provider rate sheets?

I could not get the full pdf in the op link to load, but found the "Silver" plan elsewhere on the same site for a 54 year old at $491 before any subsidy.

 

[keegs]

My understanding of it is that CA has had relatively low rates however insurers there could pick and chose who they covered.

To see the rates there go down with the implementation of community rating and a mandate would seem to be a good sign, at least in terms of pricing.

 

[MichaelB]

My understanding of it is that CA has had relatively low rates however insurers there could pick and chose who they covered.

To see the rates there go down with the implementation of community rating and a mandate would seem to be a good sign, at least in terms of pricing.

Policies offered on the state health exchange must accept all takers, once they satisfy exchange eligibility criteria.

 

[FIRE'd@51]

To see the rates there go down with the implementation of community rating and a mandate would seem to be a good sign, at least in terms of pricing.

While exchange policies are guaranteed-issue, they are not community-rated, since the premiums increase with age.

 

[ERhoosier]

My childhood best friend is an anesthesiologist in CA and he's still making a ****-ton of money and he's never complained about onerous regulations. He's also working part-time because he can do so and easily make 6 figures. What's your point again?

Clearly the US doc shortage did not begin with ACA, but most evidence unfortunately suggests that ACA has worsened the situation. Glad your friend is happy & (apparently) feels little burden from "onerous regulations". Unfortunately he is in the distinct minority. For example-according to large 2012 independent survey of ~14,000 docs, over 3/4ths are "pessimistic" about the future of US medicine (due mainly to "too much regulation/paperwork"), almost 2/3rds feel ACA has made the situation worse, most would NOT recommend medicine as a career to their children, and half plan to cut back or leave practice in the next 1-3 yrs. Sadly, over 80% felt docs had "little ability to change the US healthcare system".

A Survey of America
http://www.physiciansfoundation.org/uploads/default/Physicians_Foundation_2012_Biennial_Survey.pdf

Hopefully Congress will act quickly to address the worsening doc shortage, inc. efforts to retain good docs as well as increase future numbers. At least Grimm's effort appears to be a start. The best HI system would be rather useless without enough providers to go around.

 

[killingme]

I also have an friend who is an anesthesiologist in NYC and he requires less than a third of the medical malpractice and is subject to far fewer regulations. That's my point. Things have gotten worse in the eight years since that 2005 article you reference was written.

 

[explanade]

Covered California, the state health exchange, has announced rates for 2014.

The announcement is here News Magazine | Style Demo

Consumer guide is here http://www.coveredca.com/news/PDFs/CC_Health_Plans_Booklet.pdf

A comparison of Silver level policpy rates is here http://www.coveredca.com/news/PDFs/SilverPlanRatesChart.pdf

Main difference between the Silver and more expensive or less expensive plans appears to be higher co-pays. They all have the same out-of-pocket maximums. But the difference in monthly premiums, depending on age, is greater than the difference in the different co-pays.

So why get higher plans unless you expect to use medical services at least twice a month?

 

[Disappointed]

Main difference between the Silver and more expensive or less expensive plans appears to be higher co-pays. They all have the same out-of-pocket maximums. But the difference in monthly premiums, depending on age, is greater than the difference in the different co-pays.

So why get higher plans unless you expect to use medical services at least twice a month?

How about access to doctors and hospitals, any differences?