Grandfathered plans are an absolutely screaming deal. You can do an HSA plan with a $2000 deductible and low OOP max, fully fund the HSA ($7,200) and come out way ahead at modest cost. This let's you do things like vision / dental / chiro / accu / whatever day to day stuff on the HSA, then keep costs controlled (after 2K) for a major issue. If you don't end up using the HSA you can basically use it in retirement.
The obamacare bronze HSA plans (which actually cost a bit more) have a $4,800 ind deductible and something like a $13K (!!) out of pocket max and something like a $9K+ family deductible limit. And they cost more. This is totally unworkable absent the subsidies.
I like obamacare, but something happened as part of obamacare that has CLEARLY driven up costs. Is it the lack of limits (ie, $10M in coverage during last weeks of life?) Is it some sort of other mandate?
One area where govt care is better priced is for the elderly. The grandfathered / free market type plans get expensive at 60 years +. The obamacare plans are more of deal here (relatively). At the 20 year old range obamacare is horrible for the coverage if you actually have to pay for them.
>I like obamacare, but something happened as part of obamacare that has CLEARLY driven up costs. Is it the lack of limits (ie, $10M in coverage during last weeks of life?) Is it some sort of other mandate?
That's an easy one, Obamacare mandated that insurance companies couldn't charge more than X times as much for their most expensive plans vs. their cheapest plans, The people pushing it were either tremendously ignorant or outright lying and claimed that this would make plans cheaper, while critics rightly predicted that instead of making the most expensive plans cheaper they would make their cheapest plans more expensive.
This and the cap on the profit margin[1]. The logic in this case is even more bizarre. A regular company can increase its profit either by raising prices or by reducing costs so it strives to do both. An health insurance firm can only do the former. If an insurance firm were to reduce its costs then it would have been forced to reduce the price to remain within the profit margin. But if it increased them instead then it could raise price and get more money in the same profit margin.
When you've just had the government mandate that everyone in the country has to buy at least the lowest tier of your product, why would you take any losses at the top when people are forced to pay just about any price at the bottom?
It’s the preexisting injury part that jacked up the prices. They aren’t allowed to deny enrollment or charge significantly higher premiums if some was has cancer or something. And that totally makes sense morally, but that causes the risk burden to be offset on the aggregate of the subscribers resulting in higher premiums for everyone.
It would be kind of similar to forcing auto insurance carriers to afford coverage to cars they didn’t previously insure after they had already been in an accident.
The insurance mandate was supposed to solve that problem.
And the requirement that 80% of premiums paid had to go to paying for care was supposed to prevent insurance companies from jacking up prices to increase profits.
Neither actually made an attempt at fixing the underlying problem of health care being expensive.
I've NEVER seen an employee denied (or asked) about their medical conditions ever. The enrollment paperwork to the carrier is like basic address / name / effective date for coverage. That is it.
Last year I went to Mayo Clinic. I have ACA insurance, but it is HMO-only (all ACA insurance in Indiana is HMO, not PPO), and Mayo is not in network. I actually considered getting married just so I could get PPO insurance (life change event) and be covered at Mayo.
Since the insurance companies now have to cover pre-existing conditions, and don't want to do that, they came up with another plan: don't answer the phones except during open enrollment. I tried calling several insurance companies (major carriers) just to get quotes for health insurance, and none returned my call. Some had phone trees that went in a circle so you could not get to a person. I did get one broker to talk to me, and he said pre-existing conditions weren't covered for 24 months. First, that's a lie, and 2nd, it's illegal (ACA outlawed this practice).
By only accepting applications during open enrollment, the insurance companies have effectively done an end-run around the law against pre-existing conditions.
Note: this is for an individual to get insurance. I'm sure companies can get insurance for their employees any time they want it.
Follow-up: it turns out that if I did have PPO insurance and was covered at Mayo, then with the same bill from Mayo it would have cost me $8000 more with coverage than it did without insurance, paying cash. That's truly f'd up!
> And prior to the ACA rule taking effect, denial for preexisting conditions was common practice
Bigger than denial was recission, where if you ended up with an expensive to cover condition, your insurer would fine-tooth-comb your history for evidence that you had a preexisting condition that has not been revealed, cancel your coverage, and leave you uninsured and uninsurable; recission for reasons other than proven intentional fraud was prohibited by the ACA, which is a pretty big deal.
I've been at a small company (circa y2k) that looked at group insurance, and decided against it specifically because of one employee's pre-existing conditions would have made the plan more expensive. Boss was a little too forthcoming with that information, and sure enough, when the employee moved on, we all got insured. Thankfully, that's illegal now.
Yep; I knew a few small businesses where an employee got cancer or whatever and their insurance company let them know that their plan would become significantly more expensive and "hinted" that, to avoid this, maybe the employee in question could be fired for some reason...
And before ACA, the prospective employee would normally have to show evidence of continuous creditable coverage before being added to the new employer group plan. This is how pre-existing conditions were handled - if you had always had coverage, OK, but if you went uninsured for a while and then tried to re-join a group, tough luck.
Grandfathered plans are an absolutely screaming deal. You can do an HSA plan with a $2000 deductible and low OOP max, fully fund the HSA ($7,200) and come out way ahead at modest cost. This let's you do things like vision / dental / chiro / accu / whatever day to day stuff on the HSA, then keep costs controlled (after 2K) for a major issue. If you don't end up using the HSA you can basically use it in retirement.
The obamacare bronze HSA plans (which actually cost a bit more) have a $4,800 ind deductible and something like a $13K (!!) out of pocket max and something like a $9K+ family deductible limit. And they cost more. This is totally unworkable absent the subsidies.
I like obamacare, but something happened as part of obamacare that has CLEARLY driven up costs. Is it the lack of limits (ie, $10M in coverage during last weeks of life?) Is it some sort of other mandate?
One area where govt care is better priced is for the elderly. The grandfathered / free market type plans get expensive at 60 years +. The obamacare plans are more of deal here (relatively). At the 20 year old range obamacare is horrible for the coverage if you actually have to pay for them.