Who is Losing their PPO Health Plans?

[Selah]

We seem to want to throw the baby out with the bath water, so to speak.

We have the best trained and competent health care professionals in the world but have some of the poorest overall health care. Yet the first time we attempt to fix that a segment of our political population doesn't want to try and make it better they want to scrap ACA and go back to the way it was. To think that we had the best health system for our citizens is to be oblivious to reality.

To expect something as far reaching and complicated as the ACA to be perfect right out of the box is not very realistic either. Perhaps what we need is to stop whining and make our elected official work together to build on what was started and fix what's broke and improve what is not.

[Mariner]

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As for the public option argument, 90 million Americans are on Medicaid and another 50 million are on Medicare. Add to that, millions more who are getting their ACA coverage subsidized by the Fed. We may as well just go ahead and put everyone on a Federal system, that's where we're headed anyway.

 

I believe that has been the plan all along to ultimately have a federal system. But with the track record of the federal govt. running anything, it isn't something I want. Some federal bureaucrat in charge of my health care? No thanks. How's that working at the VA?

[Daveh]

Mariner, the most likely system would be in the nature of medicare for all and that is working quite well. http://healthleadersmedia.com/content/QUA-321948/Medicare-Advantage-Outpaces-Private-Insurers-on-Quality#%23

[Kirk W]

Mariner, the most likely system would be in the nature of medicare for all and that is working quite well.

Your story is about Medicare Advantage, which means an HMO. Good luck with that if you travel extensively! It is very easy to find stories that claim either success or failure of the ACA, just to support whatever view you hold. For us, we were already on Medicare and the new law destroyed our company supplied supplement and has cost us a very large amount of money.

[Daveh]

I know exactly what it was Kirk. The point is that it outperforms commercial insurer plans with regard to quality. This is also true of medicare generally which operates with a 2% overhead and is the primary mechanism for pushing quality measures. You have mentioned your situation before. A national policy cannot be judged based on the experience of one individual. Additionally, employers constantly scapegoat the ACA for their own cost saving measures. In your particular situation, as someone over 65 that gets medicare, I am unclear how the ACA provisions would impact your supplemental policy. I am sure many under 65's on this board would be very happy to change healthcare positions with you.

[Mariner]

 

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. Add to that, millions more who are getting their ACA coverage subsidized by the Fed.

 

 

This is another statement that really gets me fired up. It's NOT the fed who is subsidizing the ACA....it's the American taxpayer!!!!!!

[TXiceman]

 

 

This is another statement that really gets me fired up. It's NOT the fed who is subsidizing the ACA....it's the American taxpayer!!!!!!

The American tax payers is what comprises the Federal government.

 

Ken

[Daveh]

mariner, Aren't you also over 65? Certianly everyone can contribute but I don't understand why some of you come here to offer nothing constructive except to voice your disdain for taxes and the government. We get it!!!!!!!!!!!!!!!!!!!!! It does nothing to further the discussion or help those facing loss of their plan.

[Mariner]

I've never said anything against paying taxes, lord knows through the years I've had some hefty tax bills. It's just that it's so easy to say, "The feds will pay for this or that." When in reality the American taxpayer is footing the bill, and ALL those bills are coming due. $18 Trillion & counting. Speaking of losing your plan, Utah this morning shut down their 10th exchange leaving who knows how many without any health insurance. One day you're covered, the next nada.

[Jack Mayer]

The simple answer is that if you are domiciled in one of the states that will no longer offer PPOs there is NOTHING you can do that I know of. Other than moving domicile, you are going to have to deal with an HMO. I'm in that boat myself, but I'm lucky that I will go on Medicare 1 June. So I have only a short time to deal with the HMO.

 

HMO's are good things in general - just not good for constant travelers.

 

The ACA PPO policies that were "accessible" to me were really no different in effect than the HMO will be. Neither will pay for most of my routine use of the medical profession. The ACA plans DID pay for a routine physical and routine testing. But NOTHING else, including prescription drugs. It was all on me, since I could never meet the high deductible. So really, I'm not worse off - at least for the short time I will be on it. The only real effect the ACA plans had on me was doubling my payments for a slightly more beneficial plan. It has helped others significantly, but not in my case. There are some real benefits that are not applicable to everyone's circumstances. Mainly guaranteed issuance of a policy. That alone is a big deal - having been through LOTS of trauma trying to get a policy issued in the past.

[richfaa]

We have been on Medicare for several years and we see no real change pre or post ACA. We travel all over as long timers and have never had a problem with Medicare. As retired Federal Employees Wife and are under the FEHBP, BC/BS and have been for many years. The rates usually go up every year but not like the increases we hear of here.

 

We have no problems with any of our Health Insurance no matter were we may be. ACA had no impact on us as we had Health Insurance that met the minimum standards and much more.

 

Wife had some surgery this summer that cost over 60K.Cost to us just over 3500.00 out of pocket .I had some minor problems cost was just under 3K total my out of pocket with Medicare and BC/BS was ..Zero.

 

IMO it has been a disgrace that the USA private enterprise could not provide Health care to all who needed it and the Government had to step in.

[chirakawa]

 

 

This is another statement that really gets me fired up. It's NOT the fed who is subsidizing the ACA....it's the American taxpayer!!!!!!

 

Sorry, didn't mean to fire you up. I assumed that everyone over the age of 10 knows that the American taxpayer funds the Federal Government. I didn't know I had to spell it out. Commonly known numbers from the 2012 Census show at that time there were 105 million Americans working, 109 million Americans on some form of means tested Federal assistance (commonly referred to as welfare), and another 45 million folks on other Federal assistance such as Social Security, Medicare, or VA benefits. You don't have to be a bean counter to know that the numbers don't add up very well when you have 105 million working and over 150 million on some form of Federal assistance. You can find these numbers on lot's of websites, liberal and conservative. I will offer this one, simply because it makes the numbers easier to understand http://cnsnews.com/commentary/terence-p-jeffrey/354-percent-109631000-welfare

 

Unlike some of the smarter people on this forum, I don't have any answers. I just know we're 17 trillion in debt and the cost of healthcare isn't helping any.

 

For the record, I'm not advocating a federal system. I simply made the observation that we are headed that way, so we might as well go ahead and do it.

 

I'm not convinced that other countries with national healthcare systems are doing so well. You have to compare like societies and like economies, and there aren't many of them out there. I still say that with the USA demographics and unhealthy lifestyle, there is no cost efficient means of continuing to keep people alive until 80 years old.

 

However, I will relate a story about England's national healthcare system, since someone mentioned them. My mother was on vacation in England and fell and hurt her arm. After suffering all night, she went to an ER the next morning. The doctor came in and examined her arm, gave her some pain pills, told her she had sprained it, and wished her well. There was no charge for the visit.

 

By the time mother landed back in the States a few days later, she was in much pain. She went directly to the hospital ER from the airport. A few hours later after some x-rays and an exam, she left the hospital in a cast with what had been a broken bone in her forearm. While in the ER, she mentioned to the doctor about the English ER experience. The American doctor simply said "well, you got what you paid for".

 

I don't know if this is typical or not, just relating a story. Maybe others who have used such medical systems in Canada or Europe, etc. can tell us about their experiences and observations.

[Barbaraok]

I beg your pardon, Social Security, Medicare, VA recipients are not on Federal assistance - we all paid into these programs (through work or through service to this country) and we are now getting our benefits. These are not handouts and it is wrong to suggest otherwise.

[chirakawa]

I beg your pardon, Social Security, Medicare, VA recipients are not on Federal assistance - we all paid into these programs (through work or through service to this country) and we are now getting our benefits. These are not handouts and it is wrong to suggest otherwise.

 

I did not suggest that they are handouts. However, they are definitely not self supporting. They are subsidized by the Federal government. I receive SS, am on Medicare, and I'm a veteran who has used VA benefits in the past. I wasn't making a judgement on whether any of these programs are deserved or earned, simply mentioned the numbers involved.

[saydiver]

Medicare is funded primarily from three sources: general revenues (41%), payroll taxes (38%), and beneficiary premiums (13%). So yes Medicare is a partial handout, since it's 41% subsidized.

 

Source: http://kff.org/medicare/fact-sheet/medicare-spending-and-financing-fact-sheet/

[Barbaraok]

No, it is a contract between workers and the federal government to provide health care in the future for premiums paid now. How the benefits are paid out years later can be discussed, but it is not a hand-out to the people who worked for this benefit. BTW - those general revenues come from taxpayers - and that includes a lot of retirees who pay taxes not only on their pensions/IRA/401ks/403bs, but also on a portion of the SS benefits.

[Jack Mayer]

Last time I looked into it SS "could" be self supporting IF the funding had not been redirected to the general budget and spent by the Congress. That may be no longer true, but I could certainly come up with a system that WAS self supporting without much trouble. The key is to keep the politicians away from it. But what does any of this have to do with PPO plans?

 

The bottom line on the PPO seems to be that TX residents don't have one, and no amount of hand wringing and letter writing will change that. We simply have to find an alternative that works or move domiciles. And I suspect that won't really solve the issue....since if it does not work in TX it likely will not work in many other states that one would want to domicile.

[DuffMan]

What prevents an offshore company from providing "catastrophic event reimbursement" to US citizens. Say a $20K deductible catastrophic only reimbursement agreement to keep a heart attack, cancer, or other major event from burying a person. It may be illegal for that foreign company to initiate the sale of insurance to me but is it illegal for me to seek out and initiate a contract for reimbursement from them anyway? The actual terms and details of the contract can be secret between myself and the offshore company. Since it is not illegal for foreign entities to send me money and I may have to structure it for tax consequences, it may still be better than unlimited liability if I choose to go bare on insurance.

 

I can even avoid paying the ACA mandated penalty by making sure I always have to pay tax at the end of the year as the Feds can't take any actions to collect on ACA penalties other than write me a letter. If I'm one of the just above the 47% it may be a win for me.

[ray.service]

I beg your pardon, Social Security, Medicare, VA recipients are not on Federal assistance - we all paid into these programs (through work or through service to this country) and we are now getting our benefits. These are not handouts and it is wrong to suggest otherwise.

here here...2x

[Kirk W]

 

I did not suggest that they are handouts. However, they are definitely not self supporting. They are subsidized by the Federal government. I receive SS, am on Medicare, and I'm a veteran who has used VA benefits in the past.

I too get benifits from Medicare, SS and VA, but in some ways they are handouts, because as Saydiver stated, Medicare is subsidized and the same is Social Security, VA benefits, and pretty much every one of the programs that benefit citizens. Government has no money that it does not first take away from someone in the country. Since companies just pass on their taxes to the customers by way of price increases, in the end only individual people actually pay any tax. For years now our government has been trying to give more away than they take in for any of the benefit programs by borrowing money and so mortgaging our country's future and that of our children and grandchildren. Most of us are guilty of asking Congress to save money somewhere else, but increase the benefits that we get, while not increasing our taxes. We just keep kicking the problem further down the road.

[Zulu]

Just received email from www.rverinsurance.com and found my wife's 2015 BCBS PPO plan listed for the same price in 2016 -- but it's an "off exchange" plan.

 

Great news, but what gives?

[mkc]

Just received email from www.rverinsurance.com and found my wife's 2015 BCBS PPO plan listed for the same price in 2016 -- but it's an "off exchange" plan.

 

Great news, but what gives?

 

If you read the website, you'll see that any pricing for "off exchange" shown is for the current 2015 plans. They won't have the 2016 plan options or pricing available until November 1:

 

 

NOTE: This pages is for ON Exchange quoting only! If you are looking for coverage OFF Exchange then please click below for those instant quotes (Available November 1 2015).

 

 

So we have to wait until Nov. 1 to know what "off exchange" plans might be offered for next year.

[Mariner]

At last a good and open discussion on a subject that affects all of us, without straying too far into the political realm. Too bad this sort of discussion couldn't have happened years ago in D.C..

[bigboomer]

I too get benifits from Medicare, SS and VA, but in some ways they are handouts, because as Saydiver stated, Medicare is subsidized and the same is Social Security, VA benefits, and pretty much every one of the programs that benefit citizens. Government has no money that it does not first take away from someone in the country. Since companies just pass on their taxes to the customers by way of price increases, in the end only individual people actually pay any tax. For years now our government has been trying to give more away than they take in for any of the benefit programs by borrowing money and so mortgaging our country's future and that of our children and grandchildren. Most of us are guilty of asking Congress to save money somewhere else, but increase the benefits that we get, while not increasing our taxes. We just keep kicking the problem further down the road.

Kirk,

 

On the mark as usual. Bottomline, you do not get anything for free. In one way, shape or form we all are paying, some more than others.

[Zulu]

 

If you read the website, you'll see that any pricing for "off exchange" shown is for the current 2015 plans. They won't have the 2016 plan options or pricing available until November 1:

 

 

NOTE: This pages is for ON Exchange quoting only! If you are looking for coverage OFF Exchange then please click below for those instant quotes (Available November 1 2015).

 

 

So we have to wait until Nov. 1 to know what "off exchange" plans might be offered for next year.

 

I thought that's too good to be true! When I checked AZ Blue a few weeks ago, there were no PPO plans being offered -- just HMOs & HSA/HMOs.