TexasCHLforum.com

Posted: **Sun May 31, 2015 7:14 pm**

rotor wrote:Abraham, perhaps AJsully can chime in but I believe docs don't want to take Obamacare because even though you may have a card it is not proof that you have paid your premium and if the doc renders care such as major surgery and you have not paid the premium the doc does not get paid and he/she bites the bullet. Docs therefore don't want to take that risk and apparently there is no way for them to be sure that you have paid your premium and are up to date. I can understand why they feel the way they do. Obama built the program that way on purpose. With private insurance the doc just calls the insurance company and gets the OK right then and there. Not so with Obamacare.

That has to be part of it. When the whole thing started, you would get signed up, the HC.gov website would transmit the data to the carrier, the carrier would have to process it within a certain amount of time and have their ID card to the client, and then try to collect premiums. Many did not make payments for 3+ months, some never at all. I am sure that there were cases where big-ticket services were provided and the coverage was later canceled because no premium was ever paid. I am honestly surprised that we never had a "Rosa Parks" example of this happening and the regime pimping out this person to show how the evil, greedy, insurance companies were trying to screw over the little guy.

Mostly, I think it was a political statement that they would refuse to take ObamaCare. After about a month of OC plans being enrolled (ETA, this was February, 2014), I had a client who I sold a plan to (Not subsidized) and she said that she had made an appointment with her PCP, and when she showed up, that the lady behind the counter told her that they would not take her plan because it was an OC plan... we were in a meeting with a carrier rep from that company a day or so later and I mentioned it to him... he asked for that Dr's name and where they were located. The rep said it was a violation of the provider contract for them to refuse service to a member for ANY reason. About two days later, the client called me back and said that her doctor, personally, called her to apologize and see when she could come in to complete her appointment. I don't know what was said, but whatever it was, it worked. I think this has been fixed, I have not heard from anyone else that they were denied.

Posted: **Sun May 31, 2015 7:20 pm**

FrogFan wrote:For the past two years, I've had to buy private insurance because I "retired" from my job, haven't landed a new one, and am unlikely to do so -- I'm 61. My wife and I have saved and invested well over the years, and we live comfortably. It's just the two of us on the insurance.

We bought our first private policy from Humana through ehealthinsurance right before Obamacare became effective, for $700 a month for a $10,000 deductible policy (these are approximate amounts). As soon as Obamacare became effective, the rate went up $100 per month. We had the option last year to renew that policy, which went up another $150 per month, or go to Obamacare. Without a subsidy, Obamacare was about $400 per month more expensive than the new rate for the old policy. Also, I go to an eye surgeon who doesn't accept any policy offered through the Obamacare exchange. He accepts my existing Humana policy. My GP only accepted a couple of the policies offered through Obamacare. I had to make sure I picked one he did accept.

I tried for a subsidy, but got caught up in the approval process and didn't want to risk running without insurance. I was also concerned about what SCOTUS would do with subsidies in Texas, so I decided to continue with the more expensive version of my existing policy. There is a long and frustrating story here about how to prove you don't have any taxable income to the Obamacare bureaucrats but I'll save everyone the pain of that unless there is interest.

My understanding is that my wife and I won't have any choice but to go with Obamacare next year (this November), as my existing policy will no longer be available, but based on what AJSully421 says above, maybe I can continue to avoid Obamacare by approaching the insurers directly? Also, I'm wondering now if I should continue to use ehealthinsurance. I've had two decent experiences with them; they navigate Obamacare for you, but I wonder if I'm paying more than I should by going through them.

I don't know what it was like to buy private health insurance before Obamacare, but I can say my experience has not been good. From my perspective, the government has made quite a mess of things.

Unfortunately.... no, you can't. Any major medical plan sold after 1/1/14 has to comply with the provisions of the ACA, or you will be subject to the individual tax penalty for not having a compliant plan. The reason for going directly to the carriers is if you know that you will not qualify for any subsidy, or for only a small one, Going directly to the carriers through an agent only keeps you from paying the 5% additional tax on all plans sold through HC.gov, or state exchanges (Texas doesn't have an exchange). You will get the exact same coverage either way, you will just pay 5% more on HC.gov for no reason. I know it is confusing....

Posted: **Mon Jun 01, 2015 8:38 am**

AJSully421,

You're a wealth of great information.

I thank you.

Any speculation on what percentage of those qualified for O.C. have declined enrollment and are going bare?

Plus, what's the penalty for going bare?

Thanks!

Posted: **Mon Jun 01, 2015 9:14 am**

Abraham wrote:AJSully421,

You're a wealth of great information.

I thank you.

Any speculation on what percentage of those qualified for O.C. have declined enrollment and are going bare? I have no idea, and only HC.gov would have the number of those who qualified for subsidies but did not take them... think you will get a report of those numbers from the regime?

Plus, what's the penalty for going bare?

Penalty varies, and it is a long explanation... First, if you are able to afford coverage (Determined as the cheapest bronze plan available in your county being less than 8% of your household's Modified Adjusted Gross Income, or a group plan being offered that is less than 9.5% of your household income) if you can afford either, and do not get coverage, they you are subject to an annual tax penalty for 2015 of $325 per adult and $162.50 per child (To a max of $975 total for the family) OR... 2% of your income, whichever is HIGHER. The penalty is not an "all or nothing" situation, it is calculated per month, so basically it is a $27.08 per month penalty for an adult, so if you qualify for an exemption or hardship for a few months and others you do not, it can be less than that full $325 this year. This amount goes up in 2016. Now, even that 2% of income penalty is capped to the cost of the national average of the cheapest bronze plan available for all of the members of your family. The point is that they are trying to make it cheaper to actually get ACA compliant coverage, even if it is a crappy high deductible HMO.

Now, there are about 20 exemptions and 15 hardships such as if you only go without coverage for 3 months, if you are evicted from your house, if you live abroad, are incarcerated, got a disconnection notice from a utility company and several others. Keep in mind that not all of these are "Full year" exemptions or hardships. If you get a utility disconnection notice in January, you are not exempt all year from having to buy coverage.

Also, those "medical expense sharing ministry network" things are considered an exemption and would keep you from getting a penalty.

According to the CBO, about 90% of those who do not have coverage will not be penalized.

List of exemptions from the IRS site: http://www.irs.gov/Affordable-Care-Act/ ... Exemptions

List of 2015 hardships from HealthCare.gov (Considered an authoritative source) https://www.healthcare.gov/fees-exempti ... exemptions

Thanks!

Posted: **Wed Jun 03, 2015 3:16 pm**

Obamacare sticker shock: Big rate hikes proposed for 2016
June 02 NEW YORK
Hold onto your wallets ... many insurers want to substantially hike rates on Obamacare policies for 2016.
Many are proposing double-digit premium increases for individual policies, with some companies looking to boost rates more than 60%, according to a list posted Monday by the federal Centers for Medicare & Medicaid Services.

http://money.cnn.com/2015/06/02/news/ec ... are-rates/" onclick="window.open(this.href);return false;

Posted: **Wed Jun 03, 2015 3:52 pm**

The Annoyed Man wrote:Yes. I'm on it. Except that now, I pay $706.00/month to cover my wife and myself, instead of the $486/mo I paid last year (also under Obamacare) for the exact same policy, and instead of the $280/month we paid before Obamacare.

That is why I cannot EVER agree that 90% of all democrats are anything other than selfish pudknockers, and the other 10% are so disrespectful that they think they have a god-given right to direct MY life. And ALL of them are costing me a lot of money. I curse their fecklessness.

But other than that, I have no particular opinion in the matter.

My mother has a BCBS policy through the exchange. If it wasn't available last year for her, I have no doubt she wouldn't be here this year. So I'm grateful that it was available. But her policy more than doubled in price this year, and went from a 500 deductible to a 1500 deductible. Even though they say it's the same policy. And the copays never stop. We were having to go 3-4 times a week to the eye docs for her glaucoma a few months ago. $50 copay for each visit.

Marty

Posted: **Wed Jun 03, 2015 4:21 pm**

Abraham wrote:Have you used it?
Was it efficient or a nightmare?
Thanks!

I didn't read the whole thread, but what is "Obama Care"? As near as I can tell it's a mandate to buy private insurance. So are you asking if we like our private insurance carriers or are you asking about the process of selecting a carrier via the website?

Posted: **Wed Jun 03, 2015 5:24 pm**

cb1000rider wrote:
Abraham wrote:Have you used it?
Was it efficient or a nightmare?
Thanks!
I didn't read the whole thread, but what is "Obama Care"? As near as I can tell it's a mandate to buy private insurance. So are you asking if we like our private insurance carriers or are you asking about the process of selecting a carrier via the website?

As far as I'm concerned, ALL currently available medical insurance is now "Obummercare".

Posted: **Wed Jun 03, 2015 5:39 pm**

To the OP,
you now have a lot of info, what's your plan ?

Posted: **Thu Jun 04, 2015 12:37 am**

I have had health insurance with the same company for over 15 years. When I signed up with them,it was a privately administered policy offered by one of the largest private hospital groups in Texas ("Scott & White" then , now merged into "Baylor Scott & White Medical System"). When I started with them, I switched to them because they offered "small group" plans the same benefits available only to "large group" plans with any other carriers. As a small group employer (having less than 50 employees), all other small group plans had pre-existing condition provisions where they could exclude any employee from coverage for certain pre-existing issues, such as any type of heart disease, cancer, immune system disorders, etc... They could just reject coverage at their option. I had two long time employees that had heart issues...one had had a heart attack and the other had been diagnosed with hardening of the arteries and my carrier at that time dropped them from the company plan. In a "large group plan", the carrier cannot discriminate against any one person and everyone pays the same rate regardless of health history under the theory that by spreading the risk over a larger number of people, the overall risk to the carrier is not impacted negatively. Scott and White made that same offer to small group employers which was a HUGE benefit, because those who were uninsurable otherwise could then get coverage at the same price as every other employee, so i switched over to them. The coverage and care were the best I had ever experienced with any major carrier for 10 years. I later sold that business in 2005 and they allowed me to retain my group plan even though my group only consisted of my immediate family at that point. The premiums for our coverage had gone up some each year just like the overall market did, but was still a really good value compared to BCBS, Aetna, etc... in 2007 my premiums jumped about 30% and I went to a higher deductible to keep the premium in the same range as previous year. Same thing happened the next year and the next...kept going up on the deductible to keep the price affordable. After the next increase I met with them to find out what was happening...had gone from a $500 ded, to $5,000 and the premium was more than double what it had been 4 years before. I found out that they had stopped the "large group same as small group" deal and that each small group was now being rated individually on a claim per capita basis. I had had 3 heart stents put in the year after I sold the business, and 2 months after the stents I had to have my gall bladder taken out and an adrenal tumor removed. Because the stents had not had time to heal over yet, they kept me in the cardiac ICU unit for a week prior to the surgery and a week after. It all worked out great, but all of that generated about $150k in claims. With only 3 people in my group, we had an astronomical per capita claim rate, so my premiums would go up the maximum allowed by law each year until the rate normalized. I explored getting individual coverage on wife and son and applied for catastrophic coverage on myself through the Texas Risk Pool ($10k ded. and nothing but major medical..no routine care, scripts, etc...)because I had a friend who had done that after a heart attack. I found out I wasn't eligible for the risk pool because you have to show that you are unable to get coverage on the private market...at any price. The fact that I couldn't afford the price thy were charging me was immaterial as long as someone was willing to issue coverage at any price period. I had to stay with them regardless or go without any coverage as I had joined the ranks of the uninsurable at that point. That has been the best thing to come out of the ACA...no one can be denied coverage because they have a pre-existing condition any longer, and your carrier cannot hold you hostage just because they know you can't go get coverage anywhere else. I don't understand all the talk about Doctors refusing to accept "obama care"...that's a crock. EVERY plan offered to the public now has to provide the same minimum coverages whether its issued through an "exchange" or direct from the carrier. It's the same coverage. One of my sisters is an M.D. (heart surgeon) and the other is a Pharmacist and they are fine with it. I am still with the same carrier as before ( Baylor Scott and White) and they have to offer the same product as everyone else under the same conditions. I canceled my group plan and re-enrolled under the ACA qualified plans for half the price I was being forced to pay. The coverage is not quite as good in some areas, but it is much better in others such as routine "well care" and mental health coverages which were very limited before. I see the same doctors as I always have, and now I can pick up the phone if i need to schedule an appointment with a specialist rather than going to see my primary care doc just to have him arrange it. 2 months ago I had an issue with my eye developing an occluded spot in my vision. I called the Scott and White System in Temple and told them I needed to see an opthamologist ASAP and I got an appointment for the next morning in Waco. My experience has been very good so far, and while my view may be colored somewhat by my situation, as a businessman, and having been dealing with health insurance companies for over 35 years, I'm pretty objective when it comes to comparing apples and oranges.

Posted: **Thu Jun 04, 2015 8:48 am**

sjfcontrol wrote: As far as I'm concerned, ALL currently available medical insurance is now "Obummercare".

That's my view too. Under Obamacare, my health insurance has gotten more expensive. The care I receive and accessibility of that care is really a function of the underlying health carrier, not the government.
Of course, before Obamacare, my health insurance was getting more expensive almost every year.

Another knob in the mix is the makeup of the group of insured people - IE, in my case, my co-workers. Unhealthy people drive up rates. I've told (dunno if it's true) that healthcare is more expensive for women and companies that have employees that are having children.

Largely, it's the same both pre and post Obamacare. I was hoping to see some relief in terms of how quickly the costs of healthcare were climbing, but I haven't seen that personally.

What we have seen (my job is related to insurance) is a huge turn-up in business related to Health insurance. What is interesting is that it's not just during open enrollment. It's been suggested that insurance companies are figuring out how to make money on this Obamacare thing - IE, they're able to write multiple short-term policies to bridge the gap to the mandate. My take is it the real impact to the market place has yet to stabilize out.

Certainly there are people have have been hit negatively - people who are self-employed, make too much to qualify for subsidy, and were on high-deductible plans would have big rate increases.

Posted: **Thu Jun 04, 2015 8:57 am**

Are you in prison? If so, how's that working out for you?

Posted: **Thu Jun 04, 2015 9:32 am**

My mother in law is on it. She lives with us and I pay the bill so I know how much it costs. My wife went through heck and back to sign her up for it, submitting and resubmitting information several times. The website and service is atrocious. I forget exactly which plan she is on or what it's called but it's the highest deductible option.

She was finally able to get coverage at a cost of $567 month and then suddenly went up to $647/month. She has used it a couple of times for routine things and I think so far the plan has paid for the few things it covers without having to meet the crazy high deductible first.

Now for my mother in law, who immigrated to the US less than 5 yrs ago, and had not paid into the "system" she was not immediately eligible for medicare yet and because of her age (70) health insurance for her was not affordable through private means. And when she becomes eligible for medicare and medicare part B?, we have to pay the cost (really high, almost $700 a month) although it covers much more than Obamacare.

So Obamacare for us is an expensive better than nothing stop gap option until she can get medicare which we still have to pay for but covers much more. In the long run medicare is the most affordable option for us given cost/coverage.

At least that's the way I understand it.

Posted: **Thu Jun 04, 2015 10:11 am**

Taypo wrote:Are you in prison? If so, how's that working out for you?

I'm not sure I follow.

Posted: **Thu Jun 04, 2015 10:18 am**

I have coverage through my company but OC has affected that too. Our deductible increased 10 times and the prices of some of the medications my wife and I were taking increased as much as 50 times. That's not a typo. One medication my wife was taking went from $30 for a 90 day supply to $1500 for a 90 day supply. If she hadn't managed to switch some meds around, and we hadn't gotten lucky with a couple new generics hitting the market at the same time, our prescription costs alone would have gone from about $800 a year to somewhere between about $6,000 and $12,000 a year. We used to have a $600 family deductible now it's $6,000. OTOH, I work for a good company and for now anyway, it's funding the deductible via an HSA account so my actual deductible expenses have decreased.

I'm going to get slammed at retirement because my wife is younger than I am and while I "may" get Medicare she won't qualify for several more years. We're not going to qualify for any subsidies so we'll get gouged to pay for all the freeloaders.

TexasCHLforum.com

Are On Obama Care? If so, how do you like it?

Re: Are On Obama Care? If so, how do you like it?

Re: Are On Obama Care? If so, how do you like it?

Re: Are On Obama Care? If so, how do you like it?

Re: Are On Obama Care? If so, how do you like it?

Re: Are On Obama Care? If so, how do you like it?

Re: Are On Obama Care? If so, how do you like it?

Re: Are On Obama Care? If so, how do you like it?

Re: Are On Obama Care? If so, how do you like it?

Re: Are On Obama Care? If so, how do you like it?

Re: Are On Obama Care? If so, how do you like it?

Re: Are On Obama Care? If so, how do you like it?

Re: Are On Obama Care? If so, how do you like it?

Re: Are On Obama Care? If so, how do you like it?

Re: Are On Obama Care? If so, how do you like it?

Re: Are On Obama Care? If so, how do you like it?