Who is Losing their PPO Health Plans?

[Zulu]

Silver plan because they qualify for a subsidy.

 

This sounds like you're saying a plan's "metal" (Bronze, Silver, Gold, Platinum) determines if a plan is qualified for a subsidy.

 

If so, that's not true. Subsidies are for all Exchange plans -- if you meet the financial guidelines. Non-exchange plans do not qualify for subsidies.

[Daveh]

Zulu you are right all the plans are eligible for subsidies but there is also the possibility of additional cost-savings reductions which require a silver plan. If you are getting a bronze it is worth checking out whether these silvers are a better deal. Dave https://www.healthcare.gov/lower-costs/save-on-out-of-pocket-costs/

[Barbaraok]

Insurance companies won't always have your back either. Dear friend of mine recently found this out. He has lung cancer. He wants to go to a major cancer center in another state. His insurance said no coverage. Local doctors have basically wrote him off. Sad. Please do let us know what you were referrring to.

 

Does the state have a medical school. That would be the place I'd turn next.

[GlennWest]

Actually he has bcbs of Texas. Don't know which plan. Knowing him as I do that won't stop him. He has funds but will deplete them likely. I shared this because of poster stating heath sharing will let you down. Any will

[richfaa]

Reading of all the problems folks are having with health Insurance is very discouraging .A health issue can bankrupt you and change your lifestyle. I had motioned that Helen had some not so serious surgery that was billed at over 63K total. If we did not have good health Insurance that covered nearly all of that total we would have been out of the RV lifestyle.

 

We like most here travel all over the country and have never had a problem with health care or prescriptions . We use Walmart for prescriptions and it took one phone call lasting maybe 3 minutes to have our prescriptions transferred from Ohio to Florida. They were ready for pickup 15 minutes later.

BC/BS is excellent in handling billing and payment .We have never had a problem.

[trostberg]

My $10,000 deductible plan with Humana was discontinued last year so I am on the exchange with a subsidy. I was paying $200 a month for Humana before they eliminated the plan. To buy it off the exchange would have been over $700 a month last year. I cant afford a plan off the exchange but my plan with a subsidy may or may not cover me as I travel. So its all a gamble.

[Daveh]

For people under 65 not working, or even those working, consider ways to defer income until you are over 65 such as maxing IRAs HSA;s 401 K etc. and not taking any capital gains without offsetting losses to maximizing qualifying for any subsidy.

[Blues]

 

This sounds like you're saying a plan's "metal" (Bronze, Silver, Gold, Platinum) determines if a plan is qualified for a subsidy.

 

If so, that's not true. Subsidies are for all Exchange plans -- if you meet the financial guidelines. Non-exchange plans do not qualify for subsidies.

 

 

Zulu you are right all the plans are eligible for subsidies but there is also the possibility of additional cost-savings reductions which require a silver plan. If you are getting a bronze it is worth checking out whether these silvers are a better deal. Dave https://www.healthcare.gov/lower-costs/save-on-out-of-pocket-costs/

 

Thanks for correcting that, Daveh. One of my big problems with how the plans are presented is the lack of transparency, in that you input your income and it comes back and tells you what you qualify for, but not WHY you qualify for that.

 

So people will say, "I have a plan that costs me $30/month with a $500 deductible," and that's just impossible given the cost of health insurance. Or, well, it's possible only if the person has a very low income and has selected a silver plan on the exchange, which gives the added benefit of drastically reduced deductibles and out-of-pocket maximums via "cost-sharing reductions." But do they know that's why they have such a great plan? Do other people know that this premium and plan isn't available to everyone?

 

I made the mistake of conflating "cost-sharing reductions" and "subsidy" into just "subsidy"--just the sort of lack of clarity that bugs me. And I can't edit my post to fix it.

[Mariner]

Granted I'm over 65, have medicare and a great PPO, but that doesn't stop me from worrying about what's happening to others. When all this started both my children's families were immediately kicked off their healthcare plans that they had been on for a number of years. Then after shopping around for new insurance, they found their premiums had doubled, and they were no longer able to see their dr.'s who they had been seeing for years. And now my granddaughter who recently married can't afford it, so she plans on paying the fine since it's cheaper than the insurance. And this is called a better way? I think not. And what about all the people who have been put on part time because employers can't afford to offer insurance to employees anymore. Some are content in saying I've got mine, and not a thought of others less fortunate.

[richfaa]

ACA is really difficulty to understand try this "http://blog.al.com/wire/2013/09/use_this_calclulator_to_find_o.html

 

We are not on ACA but have helped several to apply. Politics aside one can in most cases find a plan they can afford with the coverage they need.

 

Most were "kicked off their employer plan because the plan did not meet the Minimum standard test. Others because the employer did not want to provide adequate health insurance so passed it off to the ACA

.

Cost is dependent on income and family size. It can work.

[Jack Mayer]

Politics aside one can in most cases find a plan they can afford with the coverage they need.

 

 

It depends on your definition of "afford". My plan has doubled plus 20%. Now this year there is no plan that is viable. I'll be forced to go with an HMO that is 225% of my plan prior to the ACA. Can I pay for it? yes, I can, but I would not consider it affordable. Plus it does not have the coverage I need. So to me the ACA does absolutely nothing but make my plan have less coverage at far more money. If you are not on Medicaid or on the exchange you are basically in a very bad position. And it will get worse. As we are seeing with no PPO available in TX that is viable for a fulltimer.

[Zulu]

My wife of 63 has 10 PPO exchange plans to choose from in AZ.

 

There is only 1 PPO carrier in AZ -- UnitedHealthCare. It looks like they get a C- from the NCQA rating.

 

Prices range from $862 to $1134 per month.

 

 

In other states . . .

 

I checked a South Dakota ZIP code and Avera is now offering PPOs on the exchange.

 

Checked three Florida ZIP codes and there appears to be no PPO exchange plans offered.

 

BTW, Humana does offer one PPO Bronze plan in TX.

 

 

Finally, to those of you under 65 who are using "no state taxes" as your metric to selecting a domicile . . . you might want to change that to which state has the best PPO plan.

[Alie&Jim's Carrilite]

You might be able to use a South Dakota company if you're extremely lucky. The 3 companies there generally do not accept mail forwarding addresses. And good luck on the PPO. I'm with WellMark-BCBS- there, slipped thru the cracks and got insurance thru them. BUT, their network pretty much ends at the state border. They also raised my premium over 200% for next year. I don't qualify for a subsidy.

[richfaa]

I am just guessing but it may be that many here are at a income level to high for the ACA to be a benefit . In many cases the income may be to high for a subsidy therefore the entire cost is on the individual.

 

Without my employers contribution although not a subsidy as the ACA We might not be able to afford our health insurance plan.

 

http://kff.org/health-reform/state-indicator/state-health-insurance-marketplace-types/

[Mariner]

It's not just the monthly premiums that are going up, but the mind boggling deductibles that have to be satisfied BEFORE you see any benefit from the insurance co.'s. I agree with Jack in that affordable means different things to different people. That's why the word "Affordable" in the ACA is a misnomer.

[Smitty77_7]

We're in the Pre 65 gang, and due to hard work and living within our means we do not qualify for a subsidy. 2015 we will have spent between $25-27K for healthcare and medicines. About $17.5K for insurance.

 

This vs our budget planning numbers of about $7-10K, based upon quotes from BCBS and Aetna in 2012 - pre known impact of ACA. And those numbers were adjusted to $7K using a 15% (I felt ultra conservative.) increase per year in my spread sheet, based upon the actual numbers given to us for our combined insurance. And my estimate of out of pocket and medicines.

 

I do not have as good of an insurance policy, as I had been planning to take with BCBS based upon their 2012 info.

 

So we look at it a bit differently then those that are on the receiving end of having obtained insurance.

 

I also feel that often overlooked, is the side effect of more funds going into health care related costs - that are now not going into other parts of the economy. IMO, this could have contributed to the slower recovery. For example, we had planned on home remodeling, and also planned to paint the coach. We decided to hunker down and hold our funds, due to us the uncertainty of the full ACA impact, and the changes we expected to see in the first few years. So, that is tradesman and small businesses now not receiving our funds (above and beyond what we've now had to spend more to receive less for health care), of a budgeted $40-50K we did not spend in the economy for 2013 and 2014, and now 2015. We've also scaled back, and we probably would have anyways due to the shift to retirement draw vs working income, on our entertainment, wine selection, dinners out, and much restricted our first 5 years of RV traveling plans. Those too, are reduced income going into the economy.

 

Admittedly millions of people have 100% covered insurance in retirement, due to certain sectors being protected and just having the citizens pay for the higher post ACA costs for their coverage. Many million have had their earned private sector Group Retirement Plans either cancelled, or greatly increased in costs, again due to post ACA impact. As Private companies have the Cadillac tax, and private companies have a fiduciary responsibility to their stock holders, so can not just absorb the costs of the post ACA impact, where Government, Municipalities, School systems, etc. - can, and actually must, due to contractual agreement with unions.

 

I still am looking for how the avoidance of the ER visiting group, which never had any intention of paying for services, costs are now being avoided and not passed onto the overall costs of health care? I have not seen any costs go down in regards to medical costs?

 

And while I remain in favor of providing health care for those in need, and are not able to take care of themselves. I resent the deadbeats on meth, or just plain lazy, now getting coverage that is subsidized. IF they would even get off their behinds and go into to apply for it, which many millions have not. (My meth using 60+ year old sister is one such person. She still just walks into an ER.). And, for those that are not legal citizens, I remain against them receiving subsidized health care plans, and do not feel these millions should be able to vote. I also get ticked off, that a bill that was passed (yeah, not read), is then adjusted by supreme edict when the President is concerned that the specific portion of the ACA rolling out as it was scheduled, would impact ratings and thus votes. Pushing out deadlines, vs following what Congress passed into a law. Heck, we could save a lot of money as a country by abolishing Congress, and just appointing a King.

 

Yes, my wife and I have healthcare. Yes, even it is now many months later out then it used to be, we can get into see our regular doctors. But so far, I've personally seen more impact by ACA then help, especially to Pre 65 non subsidy qualifying people. Yes, a smaller group for sure.

 

And ticked that Congress has not even started to roll up their sleeves and try to fix the things that are known to be broken, and or, expand those that are working well. They're doing nothing that I can see, to do their jobs on altering bad legislation when needed.

 

Do not want it scrapped, do want it worked on, and do feel that it should be 'national' in nature, not state by state.

 

We're looking over our numbers now for SD, TX, FL, CA, OR, WA, AZ - while waiting to see what my Corporate Retirement Group Health Care Plan will be this year. (BCBS NC, which put in for a pretty good increase. Won't know if that same double digit starting with a '3' in the first position, increase will be reflected in what we see on Nov 15th. Also concerned that the HSA plan might disappear too.

 

And gang, I do read all the posts in a thread, this one too. I may not agree with all inputs and opinions, especially those that are politically slanted as I'm sure mine my read as too:)! But I respect everyones right to have their own ideas, and will just agree to disagree where I feel it is warranted. And also try to keep an open mind, and alter my views on a topic, or a portion of a large topic, where I learn from many of these posts.

 

Best to all,

Smitty

[2gypsies]

Very well-written post, Smitty. Thank you.

[skp093018]

 

Since our healthcare system rates so lowly compared to other countries, perhaps you could point up to a model nation which you hold as ideal so that we may all see what they do correctly. Perhaps, as we learn, we can influence our decision makers to adopt some of those better methods within our own system.

 

 

 

I can do better than that....I have recommended these books before...if you wish to find out what other countries are doing well, or not so well, read these books:

The Healing of America, by T.R.Reid

Getting Health Reform Right, by Marc J. Roberts and three others.

Regards

Gemstone

[GreyDawg]

 

 

And I don't know if you saw this in Kyle's Guide, but people in Texas who buy insurance on the exchange will have their ID cards branded with that fact. Very nice.

 

 

So what are the implications of the Scarlet X on a card? That a doctor may say "yes, we are in network for BCBS BLue Advantage HMO, but since you have an exchange policy, we won't treat you because we won't be paid as much?"

 

Can physicians be in a network for off-exchange individuals, but reject on-exchange individuals?

 

Or is it just a matter of having a card that screams "Hey, my income is sufficiently low that the government subsidizes my insurance" and the possible embarrasment of that?

[Kirk W]

Without my employers contribution although not a subsidy as the ACA We might not be able to afford our health insurance plan.

This has long been the case for many of us and remains so. Many of us who have been on Medicare for a long time are even today dependent upon contributions from our previous employers to pay for the supplemental plans, which have also been effected by the impacts of ACA. The down side of so many having had health insurance plans that were employer paid or partially paid is that so many Americans today do not understand that health insurance is a "for profit" business like any other and so someone has to pay in more than they receive in benefits. It is interesting to examine the list of countries promoted as an example of what we should do here if you also take a look at the tax rates of those countries compared to ours. An example would be Sweden with it's tax rates of 51% to 61% based upon income, compared to the US average of 22%. We can't continue to get more and more unless someone pays for it.

[richfaa]

It is true .Countries that have "national health care" pay for it through high tax rates . Someone always has to pay for it. Our Health care for wife and I will now cost us nearly 5,000.00 per year in our portion of the premiums .That is affordable for us and much less than what we read of some here .With Medicare we pay little out of pocket. With our Medicare premiums our total health care premium cost is nearly 7500.00 per year. We are IMO among the fortunate to have adequate and affordable health insurance.

 

Our premiums have gone up some nearly every year we have had employer provided healthcare insurance both before and after ACA.

 

Still IMO it is a national disgrace that our free market society could not or would not provide adequate and affordable Health insurance to every American. It is also a disgrace that the Federal Government had to step in to do it.

 

There are always folks in a society that are unable to care for themselves for many reasons and abuse program to help them .It is the responsibility of society and Government to monitor and regulate so that only those who truly need it get the help. We have never done that.The question to ask is ...Why.

[Mariner]

Just read this morning that ACA CO-OPS in Az., Co., Ia., Ky., La., N.Y., Nv., Tn., Or., Sc., & Ut., have all gone under making 870,000 Americans scrambling to find coverage elsewhere. In N.Y. alone over 200,00 will lose coverage by Nov. 30th. All this results in the loss to American taxpayers of $2.4 Billion dollars, with no way of recouping the losses. I don't understand how anyone can support this boondoggle.

[accumack]

This has long been the case for many of us and remains so. Many of us who have been on Medicare for a long time are even today dependent upon contributions from our previous employers to pay for the supplemental plans, which have also been effected by the impacts of ACA. The down side of so many having had health insurance plans that were employer paid or partially paid is that so many Americans today do not understand that health insurance is a "for profit" business like any other and so someone has to pay in more than they receive in benefits. It is interesting to examine the list of countries promoted as an example of what we should do here if you also take a look at the tax rates of those countries compared to ours. An example would be Sweden with it's tax rates of 51% to 61% based upon income, compared to the US average of 22%. We can't continue to get more and more unless someone pays for it.

Our cost of health insurance is $16776 per year (under 65) plus taxes is more than 50% of our income so we already pay more than 50% in taxes and have crap coverage. So I would welcome paying 50% to have a better healthcare system.

[Daveh]

Mariner, Can you explain why the coops came into existence and why they are failing?

[richfaa]

that is indeed interesting reading.....pick your source.