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Author Topic: Signing up for Obamacare  (Read 1093 times)
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Fireball
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« on: November 14, 2013, 12:39:39 AM »

So I, and everyone else who works in my office, move off of my employer's health insurance plan to a plan purchased from the District of Columbia Small Business Exchange effective January 1. My employer will continue to provide premium support just as they did before, which is a feature of the Small Business Exchanges.

So I'm going to get to deal with an "Obamacare" website first hand.

Creating my account, filling out my application and confirming that I worked for my employer, and thus may access to their prescreened plans and receive the premium support, all went off without a hitch. Because of certain rules related to my employer's exchange program, we can only choose from Gold-level plans. There are 114 of them to pick from. They're not an exact match for the plans we had before -- most of our previous plans had no deductibles, while almost all of these have deductibles between $500 and $2,000; on the flip side, the out-of-pocket maximum and co-pays are almost uniformly lower on the new plans than on the old ones. The premiums are all lower for me. That's in part because of age banding -- whereas before a 30 year old and a 60 year old would pay the same premiums for the same plan, now  there is a significant increase in premiums for older participants on most plans.

I've always had Blue Cross Blue Shield insurance, even when I was buying (shitty) HSA insurance as an individual on the market that didn't cover half of what the new plan will cover (but cost about as much). However, everyone in my office is buying Kaiser Permanente plans, which is making me rethink my strategy. There are way too many plans to choose from, in some ways. I know enough to stay away from HSA plans. I don't know what "POS" plans are, so I'm dodging those, too. I'm focused on a $0 deductible HMO plan from Kaiser and two $1,000 deductible PPO plans from BCBS at the moment.

I'm not going to sign up tonight, though I will do so in the next few days to a week. So far, the process has been very smooth for me. The numbers we're seeing internally regarding exchange sign ups paint a very clear picture that the states (and DC) that built their own sites are doing much, much better in terms of sign ups when compared to those that did not.

Once I've picked a plan, I'll finish the process, and update folks on how it goes.
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Ironrod
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« Reply #1 on: November 14, 2013, 03:58:40 AM »

A POS is like a hybrid of a PPO and an HMO. You designate a primary care doc who's in the network. You can get care anyplace you want, but if you go out of network you'll pay for it yourself...UNLESS your primary care doc referred you there.

We have a PPO through my wife's employer with no choice in the matter. It divides the world into low-cost and high-cost providers. We can go wherever we want, but the high-cost tier has a higher deductible ($1500 per person vs $750) and lower coverage (usually 50% vs. 80%). This year the doc that we've had for 20+ years inexplicably slipped into the high-cost tier, so now we have to throw away 20 years of history with a doc that we both like and start over with somebody else because we suddenly can't afford to see our doctor anymore -- except for preventive care, which is always covered 100% (thanks, Obama!).

Anytime we need to see a specialist or get tests done, we have to call up the insurance company to find out where the low-cost providers are. The hospital that's five miles from our house is on the forbidden list. Now if we need hospitalization we have to either go 20 miles south or into the city, alternatives that are about equally inconvenient.

I wish that we could drop her employer's coverage and buy a plan from the exchange, but that's not an option. We have to pay $600/mo for insurance that we don't like.

One of my best friends is a doctor. I asked him: If a long-time patient came to you with this problem, would you consider tweaking your rate structure to fit the insurance company's low-cost definition? He just laughed. That definition is a moving target -- even if he did bow to our insurance company's will, they will surely change their definitions again. He is thinking seriously about converting his practice to a concierge system that doesn't take insurance at all, which I guess is a rising trend among independent docs now.
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Fireball
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« Reply #2 on: November 14, 2013, 01:08:49 PM »

Well, that sounds like a pretty good argument for the much-simpler Kaiser HMO. It's kinda funny, I see the differences between PPOs and HMOs being similar to the structural differences between Democratic and Republican campaigns.
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Ironrod
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« Reply #3 on: November 14, 2013, 09:21:03 PM »

I should mention two things: First, that our situation has nothing to do with Obamacare (at least directly) since we've been subject to Romneycare for 7 years already. And second, the PPO worked out fine until BCBS subcontracted its administration to some little company that nobody's ever heard of. We still have BCBS insurance, but we have to interface with this gatekeeper.

If there's a moral to the story, it's that your insurance can change unpredictably regardless of what you signed up for. The coverage itself might be locked in, but the way it's administered is not. The HMO might be somewhat insulated from that since it's a monolithic organization, not an amalgamation of independent actors. On the downside, if you don't like a caregiver in your HMO you don't have the option of going elsewhere.
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Fireball
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« Reply #4 on: November 19, 2013, 02:49:02 PM »

So I decided on my plan over the weekend, and signed onto the DC Health Link today, pulled up my application, selected my plan, and went through the final confirmations. Altogether, today's bit took about 5 minutes. Having purchased health insurance, both as an individual, and as a manager setting up a group plan for my employees last year, this was the most painless health insurance purchasing experience I've encountered. And I'll be saving about $30 a month in premiums.
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Harpua3
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« Reply #5 on: December 25, 2013, 10:26:23 AM »

Obama is the best thing ever.
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Knightshade Dragon
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« Reply #6 on: December 30, 2013, 09:03:40 AM »

Quote
A POS is like a hybrid of a PPO and an HMO. You designate a primary care doc who's in the network. You can get care anyplace you want, but if you go out of network you'll pay for it yourself...UNLESS your primary care doc referred you there.
How is this different than most insurance carriers?  Is it partially covered or completely uncovered?  I've not checked, but obviously there is a big difference between "not covered" and "higher co-pay". 

Quote
We have a PPO through my wife's employer with no choice in the matter. It divides the world into low-cost and high-cost providers. We can go wherever we want, but the high-cost tier has a higher deductible ($1500 per person vs $750) and lower coverage (usually 50% vs. 80%). This year the doc that we've had for 20+ years inexplicably slipped into the high-cost tier, so now we have to throw away 20 years of history with a doc that we both like and start over with somebody else because we suddenly can't afford to see our doctor anymore -- except for preventive care, which is always covered 100% (thanks, Obama!).
If I understand it, that works exactly like the private insurance I have.  Most doctors that I've seen charge you per 'item' you see them about.  When he asks how you are doing if you say "Doc, I've got a headache and my stomach is bothering me, but I'm here to see you about this sucking chest wound" he's gonna charge you for diagnostics x3 which makes it a 'complex' case.  I ran into this with a doctor who I realized was nickle and diming me to death by sticking me for ~170 per visit because everything was marked as 'complex'.  Ended up switching doctors as a result to one I felt like I could have a conversation with and not get sodomized by my insurance...

Quote
Anytime we need to see a specialist or get tests done, we have to call up the insurance company to find out where the low-cost providers are. The hospital that's five miles from our house is on the forbidden list. Now if we need hospitalization we have to either go 20 miles south or into the city, alternatives that are about equally inconvenient.
Yep, ran into this too with my wife's doctor.  We asked her to join Blue Cross Network of providers and about a month later she was in.  Not sure every doctor would bother, but it can't hurt to ask. 

Quote
I wish that we could drop her employer's coverage and buy a plan from the exchange, but that's not an option. We have to pay $600/mo for insurance that we don't like.
Why is that?  I'm just not familiar, so I'm asking seriously.  Why can't you bail the coverage?

Quote
One of my best friends is a doctor. I asked him: If a long-time patient came to you with this problem, would you consider tweaking your rate structure to fit the insurance company's low-cost definition? He just laughed. That definition is a moving target -- even if he did bow to our insurance company's will, they will surely change their definitions again. He is thinking seriously about converting his practice to a concierge system that doesn't take insurance at all, which I guess is a rising trend among independent docs now.
Sounds like your insurance truly does suck.  frown   That's no good.  Any doctor that opts out of the system lost me though - I'm not paying ridiculous rates out of pocket just to 'spite the man'. 
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Isgrimnur
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« Reply #7 on: December 30, 2013, 03:35:46 PM »

They might be able to ditch employer coverage and go to the exchange, but if your employer offers coverage, you get no subsidy from the government, which likely means even more expensive coverage.
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Ironrod
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« Reply #8 on: December 30, 2013, 09:18:13 PM »

Quote from: Knightshade Dragon on December 30, 2013, 09:03:40 AM


Quote
I wish that we could drop her employer's coverage and buy a plan from the exchange, but that's not an option. We have to pay $600/mo for insurance that we don't like.
Why is that?  I'm just not familiar, so I'm asking seriously.  Why can't you bail the coverage?


What Isg said. The actual cost of our coverage is $1200 and her employer pays 50% of it, leaving us to pay $600/mo for insurance that we can't afford to actually use. We could probably get better coverage through the exchange for roughly the same $1200, but we'd wind up paying full freight.

I'm left with finding a new doctor who plays nice with our insurance company so that we can actually afford to get medical care, which we're effectively frozen out of right now. In fact, I need to do that in the next couple of weeks.
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Harpua3
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« Reply #9 on: January 25, 2014, 08:05:20 AM »

They should have called this Obama doesn't care. Stupid, stupid, stupid. Great idea in theory. Seems horrible in practice.
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TiLT
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« Reply #10 on: January 25, 2014, 08:25:42 AM »

Quote from: Harpua3 on January 25, 2014, 08:05:20 AM

They should have called this Obama doesn't care. Stupid, stupid, stupid. Great idea in theory. Seems horrible in practice.

What you had was insanely horrible. Obamacare is bad. Baby steps, man. Baby steps. Sooner or later you're all going to end up at something that actually works for everyone.

The US has been stuck in a health care swamp for ages. Trying to get out of it means stepping through more swamp, but it's necessary.

Meanwhile the Republicans keep pouring more water into the swamp while clapping each other on the back and proudly saying "we're helping". slywink
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Harpua3
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« Reply #11 on: January 25, 2014, 10:52:10 PM »

Quote from: TiLT on January 25, 2014, 08:25:42 AM

Quote from: Harpua3 on January 25, 2014, 08:05:20 AM

They should have called this Obama doesn't care. Stupid, stupid, stupid. Great idea in theory. Seems horrible in practice.

What you had was insanely horrible. Obamacare is bad. Baby steps, man. Baby steps. Sooner or later you're all going to end up at something that actually works for everyone.

The US has been stuck in a health care swamp for ages. Trying to get out of it means stepping through more swamp, but it's necessary.

Meanwhile the Republicans keep pouring more water into the swamp while clapping each other on the back and proudly saying "we're helping". slywink

I agree what we've had sucks to. It's a step forward, just IMHO, in the wrong direction.
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Ironrod
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« Reply #12 on: January 25, 2014, 11:04:13 PM »

We will ultimately get to a single-payer Medicare-for-all type of system, but the road there is long and perilous. Obamacare seems like a detour, although some pundits see it leading there indirectly.

I must say that I expected Obamacare rollout to go better than it did, based on our experience with Romneycare here in MA. The critical difference is that everybody here pulled together to make it work. The ACA will eventually find its groove because there is no alternative...but it's going to be a long, contentious process.   
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brettmcd
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« Reply #13 on: January 27, 2014, 09:54:43 PM »

I hope you are wrong with that, single payer government run health care would be an absolute disaster for most americans.   The insurance I have now is excellent insurance and costs far less then the massive taxes that would be needed to pay for single payer coverage.   It would be the same for a majority of americans.   And if you try to tell me that we will get pay increases from not having employers paying for coverage that will make up for that I will have to laugh for about 3 days at the absurdity of such a statement.   Companies will cut the coverage and keep the savings for profit, that is what companies do.
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Alefroth
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« Reply #14 on: January 29, 2014, 01:23:53 AM »

Quote from: brettmcd on January 27, 2014, 09:54:43 PM

I hope you are wrong with that, single payer government run health care would be an absolute disaster for most americans.   The insurance I have now is excellent insurance and costs far less then the massive taxes that would be needed to pay for single payer coverage.   It would be the same for a majority of americans.   And if you try to tell me that we will get pay increases from not having employers paying for coverage that will make up for that I will have to laugh for about 3 days at the absurdity of such a statement.   Companies will cut the coverage and keep the savings for profit, that is what companies do.

I don't think you understand single payer. Single payer does not equal government run health care, nor does it mean free health care. To boil it down, it basically means government run health insurance. Think Medicare for everyone.
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Ironrod
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« Reply #15 on: January 29, 2014, 03:57:21 AM »

Quote from: Alefroth on January 29, 2014, 01:23:53 AM

Quote from: brettmcd on January 27, 2014, 09:54:43 PM

I hope you are wrong with that, single payer government run health care would be an absolute disaster for most americans.   The insurance I have now is excellent insurance and costs far less then the massive taxes that would be needed to pay for single payer coverage.   It would be the same for a majority of americans.   And if you try to tell me that we will get pay increases from not having employers paying for coverage that will make up for that I will have to laugh for about 3 days at the absurdity of such a statement.   Companies will cut the coverage and keep the savings for profit, that is what companies do.

I don't think you understand single payer. Single payer does not equal government run health care, nor does it mean free health care. To boil it down, it basically means government run health insurance. Think Medicare for everyone.

Brett has an unusually sweet employer-provided plan. He does not want to hear about anything that threatens it. Which is understandable, but doesn't leave much room for agreement.
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Autistic Angel
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« Reply #16 on: January 29, 2014, 10:52:21 PM »

Quote from: Ironrod on January 29, 2014, 03:57:21 AM

Quote from: Alefroth on January 29, 2014, 01:23:53 AM

Quote from: brettmcd on January 27, 2014, 09:54:43 PM

I hope you are wrong with that, single payer government run health care would be an absolute disaster for most americans.   The insurance I have now is excellent insurance and costs far less then the massive taxes that would be needed to pay for single payer coverage.   It would be the same for a majority of americans.   And if you try to tell me that we will get pay increases from not having employers paying for coverage that will make up for that I will have to laugh for about 3 days at the absurdity of such a statement.   Companies will cut the coverage and keep the savings for profit, that is what companies do.


I don't think you understand single payer. Single payer does not equal government run health care, nor does it mean free health care. To boil it down, it basically means government run health insurance. Think Medicare for everyone.


Brett has an unusually sweet employer-provided plan. He does not want to hear about anything that threatens it. Which is understandable, but doesn't leave much room for agreement.


brettmcd's unflagging defense of his own self-interests would be somewhat more understandable if his own situation were at all sustainable.  He's living on the fourth floor of an apartment building with every unit below engulfed in flames, complaining how his heating bill will go up if the liberal firemen tamp down the inferno.

-Autistic Angel
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