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[ziggy29]

I see that you have children involved, and that obviously makes a difference.

But for DH and I in our mid and late 50s, a Bronze BCBS PPO with $5000 deductible 20% coinsurance would be around $645 a month together unsubsidized. So I'm scratching my head at these higher numbers.

This sounds about right to me, since I can get the cheapest PPO (not HMO) for about $260 a month at age 48, before subsidy, also from BCBS TX. The HMO is just a shade over $200 for me (with $6000 deductible, if it applied to me). I'm trying to figure out where these $1500 per month horror stories are coming from, because I don't see it. Even if you added 50% for tobacco usage per the law or changed the age from 48 to 64, I don't see coming close to that.

 

[NW-Bound]

My current pre-APA PPO policy for the two of us in the 55+ age group is $552/month. That is the new premium that they sent us last month, and will be valid till 10/2014. I assume that they are not going to cancel the whole plan, else they would let me know by now.

The policy is extremely simple. We pay for 100% up to $10,000 a year. After that, the insurer pays 100%. The policy does not cover drugs, and that may make a difference.

When I dropped my 24-yr old son who has his own HI now, the premium was reduced by around $50. Youngsters rarely get sick, but that still surprised us.

Also last month, they reimbursed us for $46 for the premium rebate, which means they did not overcharge.

If I go to an ACA plan, what I have seen so far indicates that I will likely need a subsidy because the premium will be higher.

 

[ziggy29]

The policy does not cover drugs, and that may make a difference.

Will that even be allowed the next time your policy renews (10/2014)? I thought all ACA-compliant policies had to cover prescriptions?

 

[NW-Bound]

Mine is pre-ACA, so is not ACA-compliant. Does it have to change?

I like my policy because my OOP is very simple. If we are 100% healthy, our expenses will be just the premium of $552X12 = $6624 plus a few hundred for annual exams.

If we are really sick, it will be $16,624 (premium+deductible), plus some prescription drugs which so far are not a whole lot.

 

[ziggy29]

Mine is pre-ACA, so is not ACA-compliant. Does it have to change?

Not necessarily. But if your plan decides to significantly change (increase) the copayments, deductibles or out of pocket limits, if they change those numbers it *could* lose its grandfathered status. Apparently quite a few people are seeing this happen now.

 

[Katsmeow]

I see that you have children involved, and that obviously makes a difference.

But for DH and me in our mid and late 50s, a Bronze BCBS PPO with $5000 deductible 20% coinsurance would be around $645 a month together unsubsidized. So I'm scratching my head at these higher numbers.

To get down to a $3000 deductible, doctor visit copays, etc, we would need the Silver PPO and pay $908 a month together, unsubsidized. We would rather apply the premium difference toward the higher deductible, if needed.

This is all less than we are paying now.

My quotes are coming directly from the insurance companies for my county and our birth dates. The deductibles are for each individual.

I suspect you also live in a part of Texas that is lower cost. While he aren't in Houston, we are in an adjacent county and premiums are higher.

I'm using the plans on Valuepenguin (link in my past post) where you can put in County and family age and size. In our case, it is just me and 2 teenagers (one over 18). DH is already on medicare.

 

[NW-Bound]

Not necessarily. But if your plan decides to significantly change (increase) the copayments, deductibles or out of pocket limits, if they change those numbers it *could* lose its grandfathered status. Apparently quite a few people are seeing this happen now.

The $10K deductible will eventually get encroached by the rising healthcare cost, and which means the premium will be so high that it is no longer a high-deductible plan, and no longer attractive to people who prefer such a plan. This plan will not last forever.

By the way, we have had this $10K deductible for several years, and the savings in the premium allows us to save up near $40K in an HSA. We have spent $20K of that in 2 consecutive years.

This insurer does not offer any ACA plan in my state. I do not know about its participation in other states.

 

[audreyh1]

Mine is pre-ACA, so is not ACA-compliant. Does it have to change?

I like my policy because my OOP is very simple. If we are 100% healthy, our expenses will be just the premium of $552X12 = $6624 plus a few hundred for annual exams.

If we are really sick, it will be $16,624 (premium+deductible), plus some prescription drugs which so far are not a whole lot.

The drug thing. If you have to fight cancer, the drugs are incredibly expensive and usually cost way more than anything else. Chemotherapy drugs can run $10K a month.

 

[audreyh1]

I suspect you also live in a part of Texas that is lower cost. While he aren't in Houston, we are in an adjacent county and premiums are higher.

I'm using the plans on Valuepenguin (link in my past post) where you can put in County and family age and size. In our case, it is just me and 2 teenagers (one over 18). DH is already on medicare.

Our area is not one of the cheapest zones. Not the most expensive, but the next most I think.

 

[NW-Bound]

The drug thing. If you have to fight cancer, the drugs are incredibly expensive and usually cost way more than anything else. Chemotherapy drugs can run $10K a month.

I should have read the fine print a lot more carefully.

However, my son last year and myself this year were treated with drugs under professional care, and we did not have to pay. However, minor prescription drugs we picked up at the pharmarcy, we had to pay.

 

[audreyh1]

I should have read the fine print a lot more carefully.

However, my son last year and myself this year were treated with drugs under professional care, and we did not have to pay. However, minor prescription drugs we picked up at the pharmarcy, we had to pay.

Drugs administered in office covered - that makes much more sense.

 

[MichaelB]

This just really surprises me as I'm not seeing high prices to stay in our PPO and it'll be quite a bit less that I was paying in the high risk pool.

There must be huge discrepancies between states.

Yes. There are also huge differences within the states. Florida has one of the highest number of policy offerings. I build a spreadsheet to look at our choices and there are differences of 2.5x among policies for similar coverage. Medical loss ratio limit profits, so I assume the difference is driven by network.

My short list is down to 2 carriers, 2 policies each. Both are national (BCBS & Humana) with national network coverage and there still is a premium difference of almost 30%.

 

[Dawg52]

Yes. There are also huge differences within the states. Florida has one of the highest number of policy offerings. I build a spreadsheet to look at our choices and there are differences of 2.5x among policies for similar coverage. Medical loss ration limit profits, so I assume the difference is driven by network.

My short list is down to 2 carriers, 2 policies each. Both are national (BCBS & Humana) with national network coverage and there still is a premium difference of almost 30%.

And then there is MS who only has one carrier offered in my county, Magnolia Health. They handle the state's medicaid program. A very limited network for my area too. Of course my doc is not on the list and one of our 2 hospitals not included. Their rates are also well above the national average.

So if you are uninsured it beats nothing. But if you want something half way decent, you will have to go outside the exchange and forget subsidies. Maybe other options will be added for 2015.

 

[Texas Proud]

This sounds about right to me, since I can get the cheapest PPO (not HMO) for about $260 a month at age 48, before subsidy, also from BCBS TX. The HMO is just a shade over $200 for me (with $6000 deductible, if it applied to me). I'm trying to figure out where these $1500 per month horror stories are coming from, because I don't see it. Even if you added 50% for tobacco usage per the law or changed the age from 48 to 64, I don't see coming close to that.

Just to let you know, I have two low quotes from BCBS in the mid $600s.... the next price level is in the mid $800s...

There are many gold plans in the $1400 to $1500 range...

The one platinum plan is over $1800....


I see where the price is high!!!



Edit to add: checking the price for the low cost HMO.... it is in the mid $400s, so the increase is 40ish%....

 

[audreyh1]

Just to let you know, I have two low quotes from BCBS in the mid $600s.... the next price level is in the mid $800s...

There are many gold plans in the $1400 to $1500 range...

The one platinum plan is over $1800....


I see where the price is high!!!



Edit to add: checking the price for the low cost HMO.... it is in the mid $400s, so the increase is 40ish%....

Is this for two people, or one?

What I am seeing is that a PPO costs about 30% more than the corresponding HMO plan.

Yes, the Gold+ plans are super expensive.

 

[bamsphd]

For what it's worth, ex-Megacorp just sent me an annual COBRA open enrollment packet in case I wanted to sign up for anything in early November.

The HSA-eligible plan I used to have (roughly Silver level coverage) would be $387/mo for me only, and would be $1,046 for DW and me. (Why I cost $387 and it would cost $659 to add her is beyond me, since I'm no longer subsidized and she's three years younger.) A Gold-level PPO would cost $1,567 per month for both of us. Ouch! (Needless to say, I'm not doing any of this.)

Just received my COBRA open enrollment packet as well. Though I expect to drop my COBRA coverage, and assume the exchanges will let me enroll in time for January 1st coverage.

However I think I understand why your DW costs more. Under COBRA they have to charge you basically what your still working colleagues cost them, so your $387/mo reflects the costs of someone healthy enough to work. Your DW's $659 reflects ex-Megacorp's cost of ensuring not just healthy spouses, but also the percentage of employee spouses who don't have their own employer provided insurance because they are too sick to work.

 

[bamsphd]

There must be huge discrepancies between states.

Definitely! In my state on the exchange we can chose Anthem (aka BlueCross/BlueShield) state specific plans, or what appear to be Anthem administered "multi-state" plans.

Anthem caused a lot of controversy this year by creating a new much more restricted network of providers for their exchange plans. As far as I can tell, all the Anthem exchange plans only provide out-of-network coverage in an emergency.

Anthem is "still updating their provider network" so I don't know yet if my existing doctors are covered. Fortunately, when I started work for my final employer fifteen years ago United Healthcare who managed Megacorp's health insurance was dropping one of the two local hospitals. They added the expensive hospital back a year later, but by then I had picked doctors associated with the "cheaper" hospital. For 2014 the media reports Anthem is dropping the same "expensive" hospital from their exchange plans. Some things never seem to change.

 

[Dawg52]

I finally received my notice from BCBS of MS concerning my annual renewal. I too will not be able to keep my policy beyond 2014, but at least I will be able to keep it through 12/31/2014. Giving me plenty of time to transition over to something else. Maybe the exchange will have other insurers participating by then. Only one now. Below is an excerpt from my notice.

The healthcare reform law, known as the Patient Protection and Affordable Care Act (PPACA), will require new taxes and fees, new benefits and new rating rules that will have a significant impact on premium costs beginning January 1, 2014.
As we recently notified you, we have made a change to your benefit plan to minimize the premium impact of the January 1, 2014 PPACA requirements. Your Renewal Date and Plan Year are now December 31, 2013, and your renewal period will continue until December 31, 2014. By making this change, we are minimizing some of the components of the law’s impact on your premiums in 2014, such as delaying the following until January 1, 2015:
Impact of new rating rules,
PPACA maximum out-of-pocket, and
Expansion of additional benefits, including Essential Health Benefits.

My premium increased by $20/mo. I will just stay put and deal with this at the end of next year.

 

[zinger1457]

I finally received my notice from BCBS of MS concerning my annual renewal. I too will not be able to keep my policy beyond 2014, but at least I will be able to keep it through 12/31/2014. Giving me plenty of time to transition over to something else.

I received the same notice from Aetna for my current HD/HSA plan. When I look at the new ACA plans offered by Aetna the ACA plan most similar to what I currently have cost 70% more than my current Aetna plan. From what I can see there is very little difference in benefits between the two, the ACA plan actually has a higher out of pocket yearly limit.

 

[Mulligan]

I received the same notice from Aetna for my current HD/HSA plan. When I look at the new ACA plans offered by Aetna the ACA plan most similar to what I currently have cost 70% more than my current Aetna plan. From what I can see there is very little difference in benefits between the two, the ACA plan actually has a higher out of pocket yearly limit.

This is the part that burns me the most. I wish the government leaders would just be honest and say there are going to be winners and losers in this law and I will accept that. Instead they want to dismiss the uproar by saying the law is saving us from being in crap plans that weren't worth having. My "crap plan" has an $800 lower deductible and is 3 times cheaper than what I will have to pay after my one year reprieve is over.

 

[Texas Proud]

This is the part that burns me the most. I wish the government leaders would just be honest and say there are going to be winners and losers in this law and I will accept that. Instead they want to dismiss the uproar by saying the law is saving us from being in crap plans that weren't worth having. My "crap plan" has an $800 lower deductible and is 3 times cheaper than what I will have to pay after my one year reprieve is over.

I did see someone from the White House say that this weekend.... (well, nos sure as I cannot remember where and when I heard it).... but I think they are changing their tone a bit....

 

[Mulligan]

I did see someone from the White House say that this weekend.... (well, nos sure as I cannot remember where and when I heard it).... but I think they are changing their tone a bit....

The funny thing about all this is, this whole thing is not a surprise. On this forum we all pretty much knew how the process was going to play out. And the rules clearly were written 3 years ago that anyone who bought insurance after March 2010, would not be grandfathered, but now it's a surprise. Maybe a lot of journalists have individual health plans and are getting dinged in the wallet and they are not happy about it.

 

[HFWR]

The funny thing about all this is, this whole thing is not a surprise. On this forum we all pretty much knew how the process was going to play out. And the rules clearly were written 3 years ago that anyone who bought insurance after March 2010, would not be grandfathered, but now it's a surprise. Maybe a lot of journalists have individual health plans and are getting dinged in the wallet and they are not happy about it.

Obviously proponents put the most positive spin on the rollout, whereas opponents do the opposite...