I'm still clueless as to why the lowest cost plans are twice the premium I'm paying today, on top of having higher deductibles. You'd figure that (a) it's so much cheaper because of some policy change and should have been cancelled, or (b) it's so much cheaper that they should have cancelled it to force me to pay twice as much.
* 29, non-smoker, Pennsylvania
* PPO through Aetna
* $3000 annual deductible / max out-of-pocket
* 0% coinsurance, no annual coverage limit
* $90 per month premium, up from $85 when I first signed up, yet I got a rebate check back last year for part of it
Essentially the same plan from the same insurer, but with a $6350 deductible instead of $3000, is now ~$200/month if I were to sign up today.
In addition to what others have mentioned, your old plan had a lifetime maximum payout - maybe $1M, maybe $2M. That is removed by the ACA, and that costs extra too.
Also, there is extra cost because insurers now need to cover existing conditions - allowing you to change providers if you are already sick.
All of these extra things make it more expensive for some, but a better overall coverage - if you have catastrophic illness, you may have not been covered at the top end for all of these costs on your old plan.
Younger people tend not to think about catastrophic issues like 3+ years of cancer treatment, because new treatments are a) expensive and b) may extend your life significantly, so you may actually hit your $2M lifetime maximum, and then you are on your own, until you're bankrupt, and then the state (i.e. taxpayers) would help you out.
So, taken over 50+ years (not just this year's numbers) these new plans actually provide much better coverage, and may even take pressure off the Taxpayers for those that are under covered for their medical issues.
* Your insurer can decide not to cover a treatment because, after digging through your medical history, they find something that lets them claim it's a preexisting condition.
* Your insurer can cancel your plan, and not let you sign up for a new one.
Not only that but they send bills for services that you thought your insurance covered.
For example, I went in for a flu checkup and they charged me $90 for lab tests. This is not including $50 for copay, and $129 for the medication.
Don't ever pick kaiser as your health provider. They're very expensive. I'm still a student without a job and my parents have a normal 5-9 job that hardly pays much.
I don't know what to say when just a flu checkup costs $269 in a visit.
Dan- one of the provisions of the Affordable Care Act is that 64yr olds can't pay more than 3x the premiums of 20-somethings. Prior to the ACA the difference was on the order of 8-11x - so younger, healthier people are paying more and older & sicker people paying less. Don't be surprised if your cheap grandfathered plan does get canceled - this happened to me!
I'm going to take your post at face value. But I once was an Aetna employee several years ago, with very similar personal and insurance plan attributes as those listed in your first four bullets, but my premium was quite a bit more expensive than yours. I'm a little incredulous at how low your premium is.
Aetna is not in the business of losing money on the policies it issues. I can only think that either (1) you have failed to mention attributes of your health plan that are less than ideal (e.g., coverage cap of $25,000, but you claim that you have no coverage limit(?)), (2) that you have been placed in a very low risk pool, or (3) that you have a significant subsidy that allows to you to purchase a plan that would seem to be actuarially unsound for a for-profit company like Aetna.
Dunno what I can tell you. I got the plan through eHealthInsurance.com a few years ago. It said there's no annual limit, and on the "Coverage & Benefits" page at member.aetna.com, there's no mention of any dollar limits other than the deductible and an "Annual Durable Medical Equipment Maximum". I'm not getting any subsidies; I make too much for that.
It wasn't the only sub-$100 plan I could choose from on that site either IIRC. I went with Aetna because I was living in Blue Bell at the time, and Aetna HQ was practically in my back yard, half a mile down the street.
Edit: Found the paperwork for the thing. Everything as I said, but a $5M lifetime coverage limit.
When I was a self-employed single male for a couple of years in my late 20s, I also qualified for a plan well under $100 per month. Not sure what it would be if I didn't receive coverage from my employer, but I imagine I'm still in a low-risk pool. However, I'd think your plan would at least have a cap. I think I figured out "Annual Durable Medical Equipment Maximum" but it's funny that Google only has 3 results mentioning that phrase.
DavidAdams has a good explanation of why the Obamacare premiums will be higher than the one you are currently paying.
One thing that Obamacare is supposed to do, and it seems that it has done this in general, is make sure that the insurance plan you purchase (via monthly premiums) is worthwhile. Health insurance is cognitively difficult to evaluate, and before the Affordable Care Act many people purchased plans that offered rather poor coverage because these plans had very low premiums. (Many people are either unable or unwilling to learn the details of their health plan, or if they know the details don't mind gambling, so these types of "you think you have insurance, until you have a calamity" plans flourished.)
The ACA is supposed to prevent people from buying these "lemons" by outlawing these plans. So some plans offered by insurers were supposed to be discontinued, i.e., you couldn't stay on them, but others were "grandfathered", i.e., you could stay on them because they met the minimum qualifications set.
Obama got into a lot of trouble because he said (paraphrasing) that if you liked your health plan, you could keep it, which was false. So politically he had to backtrack and now, for the next two years, whether a plan meets the ACA standards is irrelevant, you can keep your plan regardless of how lousy it may or may not be.
It sounds, as DavidAdams speculates, that you are in a very low-risk pool, which is certainly possible. You are on the right side of 30 and may have a great medical history, which puts you in "very low risk" pool, in which case the premium you're being charged could make actuarial sense for the insurer. However, what you have not yet experienced is the flip side of age bracketing and the inevitable detriments to your health that eventually will occur. Once you turn 30, you will be in a new bracket, and your premium will go up. Percentage-wise, it will be considerable, but since you're starting from such a low base it will be modest in an absolute sense. However, as the years accumulate, assuming your plan has been grandfathered, you will likely notice that these premium increases will start accumulating to the point where you may feel the insurer is gouging you.
That is, unless the ACA remains the law of the land, in which you can just sign up for one of the Obamacare plans to join a better risk pool than the one the insurer has placed you in.
So from a game-theoretical perspective, assuming your plan is grandfathered, you should stay on it as long as you can, until the premium increases to the point to where switching to an Obamacare plan makes financial sense. This assumes that your insurer has no grounds for rescission (i.e., to retroactively rescind its coverage of your health care costs because you misled them about your medical history at enrollment). If there are grounds, then the "guaranteed issue" aspect of Obamacare plans becomes attractive.
(My startup helps companies navigate healthcare reform, so I'm a bit of an expert on this)
The key to your question are the terms "guaranteed issue" and "age bracketing." I'm going to guess that you're pretty young and at least at the time that you enrolled in your health insurance, you'd never had any health problems. They way that individual health insurance worked prior to 2014, insurance companies would offer extremely low rates to individuals, and keep their expenses down by refusing to insure anyone with even the most dubious "pre-existing condition." So if you'd gone to the doctor complaining about a pain in your side, that would be considered a disqualifying event, and they'd turn you down. Or, much worse, you'd get the insurance, pay premiums for years, then if you ever developed cancer, they'd later comb through your health records, find where your doctor wrote down that you'd had a pain in your side, cite it as an undisclosed medical issue, and refuse to cover your cancer treatment.
Needless to say, that's a very effective way of keeping the cost of coverage down: only insure healthy people who never go to the doctor. As you aged, the insurance company would start jacking up your rates to cover their increased exposure. If you ever developed an illness, you'd have no choice but to pay what they asked, because you wouldn't be able to get insurance from another company since you now had a pre-existing condition.
Healthcare reform's two boldest and most popular changes are guaranteed issue (health plans must accept you, regardless of pre-existing conditions) and outlawing "recission," or retroactively searching for disqualifying health records to deny claims. So what that means is that insurance companies can't cherry-pick the healthy people anymore, which means that the young, healthy minority is going to see higher prices for individual health plans.
Second, the ACA reduced the number of allowable age brackets, meaning that plans for the oldest people can only cost 3x what the youngest people pay. So that hits younger people again, since they have to be roped in with an older age contingent than before.
You may have heard Obamacare proponents worrying about getting enough young people into the risk pool so we don't end up with "adverse selection." They're not worried about that just because young people are feckless and think they're invincible. It's also because they know that they're the ones that are seeing the biggest rate hikes. Of course, while someone like you have to pay $200/mo instead of $90, the flipside is that a family that used to be unable to afford $1500 per month and can now be insured for $250, and that seems like a decent tradeoff, especially since, in general, young people will eventually get older and have families themselves, and they'll benefit from the changes.
The good news is that at least for the time being, you'll still have cheaper insurance, until your insurance company starts with the shenanigans and starts jacking up your rates or discontinues that line (and blames it on Obamacare whether it's true or not).
And by the way, if anyone out there is involved in a business that's having a hard time with health benefits costs, my startup is taking advantages of lesser-known provisions of the new healthcare law to save companies a lot of money. Let me know and I'll hook you up with the details. We're called Benefitter.
Is the result that many young people will not enroll and use private plans instead? As people age it would then make sense to enroll, but will the system be successful without the young (young including healthy)?
Whether you sign up for coverage through an employer, or on healthcare.gov, or ehealthinsurance.com, or an insurer's own website, it's the same companies providing health insurance today as 10 years ago. "The system" includes everyone with insurance no matter what channel they used to sign up for it. The ACA or the healthcare.gov marketplace aren't a separate system that needs its own enrollment numbers to work, AFAIK at least.
It seems more like a tax, somewhat similar to social security. You pay a lot when you're young so that you can get expensive treatments when you're older.
The $12000 out of pocket is only if you use it because you need medical help. You don't actually spend the whole $22K unless you have a lot of medical issues, and then you'll be happy that you only pay $22K per year!
When I left my last employer, I had the same company plan under COBRA. It started at ~$1000, and then went to ~$1300 at the next new year. It had lower out of pocket expenses, but those came at the cost of more monthly payment.
My current Gold medical plan (2 years later) is $820, plus dental at $120 or so. ~$950 for Gold plan, vs $1300 for my COBRA plan (in between, I had a really crappy personal plan that covered almost nothing for ~$600)
People who have employer payed medical have no idea how expensive their plans actually are
People who have employer payed medical have no idea how expensive their plans actually are
People in general have no idea how much their employers pay for any of the mandates - this is by design. If people were forced to pay all (the exact same) expenses from their own paychecks then the idea that they were getting a good deal would fade away.
Ding ding ding! It's not really health insurance, it's a protection racket based on the threat of price gouging and financial attack by billing computers spewing paperwork. But if you're just willing to pay this monthly fee, then they'll be so kind as to only require you to pay the actual cost of your services.
If healthcare reform was to fix anything, it should have mandated up-front all-inclusive pricing for well-defined services, set a percent-above-average cap on emergency services, and eliminated all of the parasitic billing middlemen that bring only opacity to the system. It needs to be reasonable for people to pay routine costs out of pocket, and only then can you have actual insurance for the unexpected. Instead, it just created a penalty for failing to patronize the existing protection racket! Although this wasn't too surprising - it's the expected fate for any grassroots movement that gains traction with professional lobbyists.
This Surgery Center of Oklahoma looks fantastic, but I'm nowhere near Oklahoma and it doesn't look like they do routine care etc. Is this one isolated voice, or perhaps part of a larger trend that I'm just out of touch with?
It's great that there's one surgery center in Oklahoma willing to compete on price. Unfortunately that's simply not reflective of the rest of the nation. I'm torn on this article because on one hand I don't like how embedded insurance companies are in the current system (it makes it difficult for a young, motivated person such as myself to find good doctors for my condition), but I also don't like the writer's tone - if he's making a legitimate point, why call it the 'Unaffordable care Act?'
You really need to follow Dr. Keith Smith - he has been writing about this topic for a long time. There is actually quite an interesting movement towards price transparency gaining traction in recent months, checkout for instance http://www.pricepain.com/why with a detailed reference list to articles/discussion on this topic from recent months
What I want is a way to actually evaluate the quality of the plans; coverage network (esp while out of state), etc. Ideally vs. my actual medical expenses for the previous year. This is much much harder, though.
(Also, wow, health insurance plans in the state/zip I tried dropped a lot over the past month!)
We do as well! Coverage networks (physicians) and actual costs are at the top of our minds. Check out sorting by 'worst case' -- while this isn't actual medical costs, if you have one or more chronic conditions, this is likely the cost you'll pay rather than just the premiums. Physician networks are harder, but we are working on it!
While it's clear on your website, "sherpa" is unusual enough that I completely missed it trying to read your URL. healths-her-pa, health-spa, health sher pa ... oh! Health Sherpa!
a great website that quickly and plainly tells me that healthcare is b r o k e n. Those prices are i n s a n e. Time to go to a local doctor and pay him directly.
This is a helpful site, but I feel like what is missing is the fine details like 'Does this plan cover the XYZ medication that my wife requires on a weekly basis?'. I ended up having to go with a more expensive plan in order to get the coverage I needed for her.
I tried signing up for an Anthem PPO plan to see how this works. I was redirected to a branded but non-functional page on https://www.ehealthinsurance.com. The form submit button did nothing at all...
The rules for health insurance brokers are a little antiquated. If you're going to sell health insurance online, someone in your company needs to be a licensed broker, and that person's name needs to be "on the building" so to speak.
High is the premium for 12 months + annual max out of pocket. We included it so people who know they'll have a lot of expenses can pick a plan based on what they'll likely pay that year rather than just the premium.
In a day in age when "red skin", "gypsy", and "chinaman" are not the preferred nomenclatures, you should consider incorporating under a name that doesn't have an ethnic component. Maybe "porter"?
* 29, non-smoker, Pennsylvania
* PPO through Aetna
* $3000 annual deductible / max out-of-pocket
* 0% coinsurance, no annual coverage limit
* $90 per month premium, up from $85 when I first signed up, yet I got a rebate check back last year for part of it
Essentially the same plan from the same insurer, but with a $6350 deductible instead of $3000, is now ~$200/month if I were to sign up today.