I'm awfully confused about what the ACA does and not permit in the way of escape. I've just been on the phone with a very helpful health insurance broker, recommended by our State Farm agent, who says that there will be off-exchange policies available as well as exchange policies. The prices quoted to me by Blue Cross so far, and all the price quotations that I've been able to find on the internet, apparently are for exchange policies: Bronze, Silver, and so on. They can be bought without going on the non-functional website, but their prices (not counting subsidies) are the same either way. Off-exchange policies have to comply with some aspects of the ACA but perhaps not all; it may be possible, for instance, to get more flexibility about deductibles. If we stay with Blue Cross, we can avoid the pre-existing condition problem. Even better, it may be that we can avoid it even if we switch to a new company like United Healthcare, which the broker believes has a better network and a better claims-paying record. He also claims that many doctors and hospitals (like the Memorial-Hermann networks and Baylor University here in South/Southeast Texas) are dropping Blue Cross at the end of this year. United Healthcare, in contrast, is preserving its network.
Because all the insurance companies are scrambling to make sense of the new regulatory environment, he can't get us options and prices yet, but he believes he will be able to do so in a few weeks. Possibly there's still some way out of this mess--some way for us to continue to buy the cheaper, higher-deductible catastrophic stop-loss coverage we prefer.
I enjoyed talking to the guy. He hates the new law as much as I do, and enjoyed hearing about Chris Matthews's hilarious new outrage about Benghazi.
13 comments:
United Healthcare is the company that runs Tricare for the military. Just FYI. That, I'm sure, is why the hospitals won't be dropping them -- too many military personel in the state of Texas.
FWIW, it's been a pretty decent company wrt timely payments and referrals for care. Their notifications of such to me are lagging, (I just recently received a letter dated Sept 30 for a hospital stay from Sept 23-26) but as long as the relevant offices are notified -- and they are because they make sure up front -- it all good.
I don't buy catastrophic coverage, so I'm not that familiar with those policies. We have a pretty good UHC policy through my wife's employer.
However, I've been poking around HealthCare.gov, and I've been interested in what they're willing to tell me before I give my personal medical and financial data to the Walmart door greeter so I can get in to poke the shelves. What that poking tells me is that Obamacare's catastrophic policies will cover up to 60% of the total cost of the catastrophe.
How is that catastrophic coverage?
More to your point, T99, I have a friend who's buying, on the Metroplex private market, catastrophic coverage and a separate policy to cover some of the more expensive "regular" items. It may be possible to avoid Obamacare's mendacity, or much of it.
Eric Hines
Eric Hines
hmm. We can hope...or change...
I am also a bit confused on the 60,70, 80 business- from what I looked at today,from Premera, the "bronze" plan for my wife and I , had a $ 866 per month payment, a $10,000 per year deductible, and unlimited lifetime expenses. So where does the "60" business come in?
I also learned what a "health savings account" is- a scam to take control of your money away- you get to deposit to an account tax free, and withdraw it tax free(I think), to use for medical expenses, OR, withdraw it with tax due and 10% penalty for other use. What a deal! now the bank will pay you about 1/10 of 1% up to a staggering 1% depending on the size of your account, but if you put it in one of their "investment options" FDIC will not apply.
Years ago I needed money badly, so I pulled 2K out of my IRA- and replaced it a couple months later. Then I made my 2K contribution for the year. For this, the IRS taxed me on the withdrawal, penalized me on the withdrawal, and penalized me on the contribution since I had then "exceeded " my 2K contribution for the year. This was a good lesson- there is no possible tax advantage worth giving the government control over my money.
Now here is another question- tomorrow I go to sit in the dentist chair and write a check for a few crowns- probably 4K or so. Now with the cheapest zerocare option I am going to have to spend an extra 5-6K a year over what I am doing now. That is going to make my non-covered dental expenses awful hard to cover, AND, as far as I know, they will not contribute to the deductible.
Point is, this zero care is gonna cut into my disposable income something fierce.
My neighbor has had really good luck with teaching hospitals in San Antonio that give great dental care. Other people swear by Mexico and Costa Rica.
In my health insurance research this week I keep running across dental insurance in the $50-70-a-month range. I resist it, because dentistry is an area that actually seems to be responding to price signals, and I know insurance will screw it up. And my dentist gives a cash discount. But the policies seem like a pretty good deal for those of us (including me) who now seem to need caps and/or root canals with distressing frequency. In fact, I can't figure out how they make money offering them.
...confused on the 60,70, 80 business-...$ 866 per month payment, a $10,000 per year deductible, and unlimited lifetime expenses. So where does the "60" business come in?
I'm neither an insurance person nor a lawyer, nor do I play one on the radio, but here's my understanding of this. You're paying $866/mo for as long as you have that policy--that's your bet that you're going to get sick, while the insurance company is betting that, no, you're not.
Your deductible simply says that if you win your bet, and you do get sick, you'll pay the first $10k of the costs of being sick that year (not necessarily with the same ailment). The $10k resets to full value each year.
If you spend those $10k on being sick and you're still sick that year (again, not necessarily with the same ailment), then, if you have a policy that covers say, 60% of your expenses, the insurer will pay 60% of the continuing expenses from your being sick. You get to pay the remaining 40%. Next year, it's that new deductible, and you're back to paying 100% until you "use up" your deductible.
In the good old days before Obamacare, there was a lifetime limit on how high the 60% the insurer paid could accumulate across all of your claims. After that limit, you paid 100%. With the unlimited lifetime expenses, the insurer will pay those 60% forever, or for as long as you hold the policy.
Oh, and one more thing. Dig out one of your pre-Obamacare medical bills with its insurance payments and your "patient responsibility" payment. Look at the doctor's charge and the "negotiated" payment between the doctor and the insurer. See the discount granted/extorted by the insurer. That delta is what cash customers pay a large per centage of in addition to their "patient responsibility" portion. Cash discount customers are being discounted from that sum.
Eric Hines
I have had good dental care in one of the teaching hospitals in the past- main complaint was it took forever- but they were good, in contrast to the VA hospital where I had a couple of impacted molars removed- that"dentist" was brutal!
I am satisfied with the quality of care, I sure would like to see the price go down some, but my dentist offers only a small reduction for payment at time of services and not a cash discount- it is annoying as there is $120 in CC fees alone in a 4K transaction.
So about the 60,70,80 business-your understanding is it is a percentage of coverage after the deductible? That seems, with the high cost of care, to be a road to bankruptcy if there is a major hospital stay.
Absolutely. It's crazy to buy insurance that leaves the out-of-pocket exposure open-ended. The exposure should be huge for whatever your average medical bills are (and are likely to be in the near future), and then drop to practically nothing after you hit a certain hump, with an ironclad lifetime limit on exposure. Any policy that isn't set up this way is a crock; you're better off banking the premiums and saving the money against a catastrophe.
You have to watch out for the "network" dodge, too. I don't worry much about the network restrictions for my ordinary annual medical problems; if a doctor is out of network (no Blue Cross contract with his office), then he's free to negotiate a cash discount with me. I do care about the network restrictionif I face a very serious illness. That's the last time I want an insurance policy that sends me to Docs-R-Us or else pays 35% of the real bill from a real doctor on the ground that it's "excessive." It defeats the purpose and means I wasted the premium, which I should have banked instead.
If Blue Cross's network is collapsing, as my broker advised me yesterday, I'll need to search for a carrier that isn't scaring off its providers. Otherwise I should go bare, and dare them to collect a fine.
...the 60,70,80 business-your understanding is it is a percentage of coverage after the deductible? That seems, with the high cost of care, to be a road to bankruptcy if there is a major hospital stay.
You bet. That's the grain of truth that gave plausibility to Obama's lie about the value of Obamacare (apart from ...Period.).
But it's a failure from lack of free markets in health insurance and in health care, or more directly, from the existence of government central management of those two industries, before BO (that's Before Obamacare...), but especially under Obamacare.
It's crazy to buy insurance that leaves the out-of-pocket exposure open-ended. The exposure should be huge for whatever your average medical bills are (and are likely to be in the near future), and then drop to practically nothing after you hit a certain hump, with an ironclad lifetime limit on exposure. Any policy that isn't set up this way is a crock....
I with you, but this should be a decision worked out in a free market, not imposed by government diktat.
...you're better off banking the premiums and saving the money against a catastrophe.
Indeed. It's what we do today via an HSA (although we have to pay a premium to get an insurance policy that lets us have an HSA under existing government health insurance diktat. It's what we did some years ago when we had no health insurance at all.
Eric Hines
Exactly. The kind of coverage I'm advocating is exactly what's been destroyed by these lying idiots, because it's "the Wild West." A free market, in which people decide what to buy on their own! Sheer anarchy!
Because Americans are too stupid to make their own decisions--they need their Betters to guide them.
Frankly, I think Progressives are projecting.
Eric Hines
Karl Denninger at "the market ticker" blog has mentioned the Oklahoma Surgery Center as an example of free market services- apparently this is a cash only operation that charges about 5 times less than standard hospitals.
My suspicion is it will not be long before alternatives like this are deemed "illegal' and shut down.
On a personal note- I called up my local Dem. Senators office today and read the staffer the riot act. Made no concealment of my anger- I have played by the rules, watched my finances, saved up and paid cash, not taken public assistance, etc etc- all the old folks wisdom- and now, after watching the profligate wastrels spend every cent that they get, now I am supposed to further support them by chewing away at MY chance to actually take a vacation now and then or maybe retire some day when I am 80 or so.
The blunt fact is, these people intend to try to turn us into serfs.
That must be so much more satisfying than my getting in contact with my three reps: Sen. Cornyn, Sen. Cruz, and Rep. Farenthold (the latter having started his career as a right-wing radio host). I'm pretty much preaching to the choir with all three of these guys.
The only thing I can do about idiots in other districts is to contribute to their opponents. But perhaps of them are soon going to be facing very interesting town hall meetings in their home districts.
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