Here's a statement of the obvious: The opinions expressed here are those of the participants, not those of the Mutual Fund Observer. We cannot vouch for the accuracy or appropriateness of any of it, though we do encourage civility and good humor.
Also to remember, there are doctors who graduate at or near the bottom of their class. How to find them? Good luck with that.
Completely anecdotal, but in grad school i lived in a house full of med students. Basically the culture was that anyone who got average or below grades became a family doctor/general practitioner. No one with any ambition (most med students) wanted to be a gp.
One parent and one school age child. Parent's employer insurance plan now gone, as of the end of 2013. Prior plan required $150/month pay-in by employee, with a $250/year deductible for both the parent and child. The ACA best choices in Michigan (affordability for them) for 2014 is:
---new combined monthly insurance cost = $691.51 vs old $150 ---dental was combined before, monthly now = $140.67 vs old $0
***Another real kicker for the new health plan is that what was a $250 annual deductible, is now $12,700 annually.
New dental plan, annual cost = $1,688.04
Update: the above health insurance has a 8.6% rate increase for 2015
Catch
The deductibles on many of these newer health plans are thru the roof. With the exception of certain no cost "preventative" services, I believe the policyholder has to pay the full deductible before the policy covers any medical services.
Is the $12,700 figure health and dental combined or just health? I'm just thinking of parents whose kids need orthodontics.
Of course , perhaps due to cost, very few kids had orthodontics during my childhood years. Now it seems to be standard fare for braces or retainers. This part of dental health might take a hit.
The $12,700 is for the healthcare plan. Everything in the dental plan, except 2 cleanings & standard xray, are out of pocket expenses for the 1st year of the plan. I don't recall the deductible for the dental plan, although it is higher compared to the previous plan with the same company; per my recollection.
I have tried to refrain from this discussion and I will after this post.
If one is over 55 (probably younger) and under 65 and does not have an employer group plan (me), paid mostly by the employer, has a MAGI of $50,000 or greater (even living in NYC or SF), you are up a river without a paddle.
I am no longer part of the voting demographics that our government cares about.
>> Private companies, who, as Accipiter pointed out, used the passage of the ACA to increase premiums.
Question: Is it not also the case that many have used ACA passage (used here meaning were forced) to decrease premiums? I read quite a bit about this too. You sound extremely orderly in your thinking, and so I wonder what you know about that too.
(Last summer, Krugman; I really wonder what if anything has changed: "Last year there were many claims about “rate shock” from soaring insurance premiums. But last month the Department of Health and Human Services reported that among those receiving federal subsidies — the great majority of those signing up — the average net premium was only $82 a month. "Yes, there are losers from Obamacare. If you’re young, healthy, and affluent enough that you don’t qualify for a subsidy (and don’t get insurance from your employer), your premium probably did rise. And if you’re rich enough to pay the extra taxes that finance those subsidies, you have taken a financial hit. But it’s telling that even reform’s opponents aren’t trying to highlight these stories. Instead, they keep looking for older, sicker, middle-class victims, and keep failing to find them. "Oh, and according to Commonwealth, the overwhelming majority of the newly insured, including 74 percent of Republicans, are satisfied with their coverage."
Medical care (like anything else) must be paid for. The government can pay for it (out of tax revenue and/or borrowing), individuals can pay for it (out of earnings and/or savings), employers can pay for it (as operating expenses - just another component of loaded employee costs). But the money comes from somewhere.
One can work to slow the rise of costs (by increasing preventive care, by reducing the use of costly ERs as primary care facilities, etc.), and one can reallocate the costs across society. But that's about it, there is no magic bullet.
Insurance is one mechanism for reallocating costs - it spreads them more evenly, instead of people relying upon luck to avoid catastrophic costs.
All the anecdotes posted just illustrate that the country is going through a cost reallocation process. Not everyone is a winner. The hope is that for the most part, the winners are the ones who were those least likely to have gotten adequate care before.
The system in place now is far from ideal, but it is a reasonable attempt at providing greater levels of care - creating a healthier society overall and thus slowing the rise in the national cost of care.
I suspect that many people didn't really know the actual insurance costs. Employees tend to focus on just at their share; they see it go up a significant percentage, and feel cheated. They should - but that's because their employer is shifting a greater portion of the cost onto them. It used to be that at large companies at least, you'd get coverage 100% paid for by your employer, and those were better plans than they give you today.
Skeet commented that his Medicare Part C costs were doubling. But like employer coverage, that's a very small part of the cost of the plan. According to HHS, 80% of Medicare participants have access to a Medicare Advantage plan with $0 premium. (The true cost of these plans in 2013 was over $10,000.)
Mona writes that without subsidies, you're out of luck on costs in NYC. But she doesn't say that in 2014, NYS individual care premiums dropped 53%.
All of these represent reallocations of costs - employers paying a lesser share, more individuals in the pool (healthier individuals covering costs of less healthy ones), etc.
Because of ACA, I am about to lose a plan that had group rates, and a group network (ACA plans tend to have very small networks). And a plan that covered out-of-network expenses (it was a PPO). So I do understand what some people are experiencing - I'm one of them.
That doesn't make it a misguided attempt at improving healthcare coverage.
You noted: "I suspect that many people didn't really know the actual insurance costs." I agree wholly with this statement.
Both at our house received an annual report from our employer(s) with about 7-10 areas of costs/expenses related to our employment. One notation was the cost to the employer healthcare plan on an individual cost basis. I don't know how common such a report is; or whether this information is readily available at internal company web sites and/or via an HR department. So, we were always aware of the cost of the "benefit".
You also mentioned: "(ACA plans tend to have very small networks)."
I will update a portion of my previous stated information.
The one adult and minor child healthcare plans I noted are with BC/BS of Michigan. The adult plan is named: Premier Bronze and the minor child plan is named, Premier Value. Lower deductible plans are available; although the monthly premium cost rises substanially. Both plans include very reasonable pricing for any meds/scripts. New information: the deductible, for 2015; will move from the current $12,700 to $13,200, "to comply with federal law", as noted in the documentation from the plan provider.
The 2015 cost summary is: monthly premium to increase by 8.6% and the deductible amount burden on the plan holder with increase 3.9%.
"New information: the deductible, for 2015; will move from the current $12,700 to $13,200, "to comply with federal law", as noted in the documentation from the plan provider. "
Yep, the govt is dictating every angle it appears.
I wonder if ex-pats who prefer out of country healthcare, but file taxes with the IRS will have to pay the new "No Health Coverage" Tax penalty? This tax looks to be about 2% of income for 2015.
>> Private companies, who, as Accipiter pointed out, used the passage of the ACA to increase premiums.
Question: Is it not also the case that many have used ACA passage (used here meaning were forced) to decrease premiums? I read quite a bit about this too. You sound extremely orderly in your thinking, and so I wonder what you know about that too.
(Last summer, Krugman; I really wonder what if anything has changed: "Last year there were many claims about “rate shock” from soaring insurance premiums. But last month the Department of Health and Human Services reported that among those receiving federal subsidies — the great majority of those signing up — the average net premium was only $82 a month. "Yes, there are losers from Obamacare. If you’re young, healthy, and affluent enough that you don’t qualify for a subsidy (and don’t get insurance from your employer), your premium probably did rise. And if you’re rich enough to pay the extra taxes that finance those subsidies, you have taken a financial hit. But it’s telling that even reform’s opponents aren’t trying to highlight these stories. Instead, they keep looking for older, sicker, middle-class victims, and keep failing to find them. "Oh, and according to Commonwealth, the overwhelming majority of the newly insured, including 74 percent of Republicans, are satisfied with their coverage."
@davidrmoran: I'll admit ignorance over pricing as most of the interest I have lies in the legal/political area. My thinking was probably along the lines of, "I see a lot of people bitching about rising rates and changing plans. It makes sense that insurance companies would raise premiums because of an influx of new people in traditionally riskier groups. Insurance companies must be raising rates." That's pretty faulty thinking, so I'm happy to trust data suggesting otherwise. In some ways, though, that does support my larger point that there has been too much prejudice, speculation, anecdote, and misinformation spread about this to have an effective national conversation unless we step back to the basic problem of assuring healthcare delivery.
Other than that, I agree with every single word @msf said. I think I'd just reiterate that the redistribution was always sort of happening anyway, it's just doing so in a far more transparent way now. The ACA -- as part of its whole "personal responsibility" bit -- now forces people to recognize that they are paying for others with their premiums and taxes, where before they didn't have to.
As a personal note, getting insurance outside of a university plan was always difficult for me due to existing health problems, so I'm pretty damn grateful to actually have insurance now without fear of denial from preexisting conditions. So hooray that.
"redistribution" - is just a dirty word for people worried that someone might get something they have under some "misconceived" notion they deserve something more that others.
as in "I worked for it", therefore someone else didn't "work for it" .
"redistribution" - is just a dirty word for people worried that someone might get something they have under some "misconceived" notion they deserve something more that others.
as in "I worked for it", therefore someone else didn't "work for it" .
Sure. I read msf's post in a hurry and just automatically glossed in "redistribute" for his better "reallocate."
Was trying to avoid explicitly political terms. Which is why I refuse to use "Obamacare."
Mona writes that without subsidies, you're out of luck on costs in NYC. But she doesn't say that in 2014, NYS individual care premiums dropped 53%.
msf,
No I did not and with good reason.
But what I will say is last year I had a fine underwritten Blue Cross plan that was very affordable. Now your President tells me my plan is not good enough for me, but his ACA plans are.
I wonder if ex-pats who prefer out of country healthcare, but file taxes with the IRS will have to pay the new "No Health Coverage" Tax penalty? This tax looks to be about 2% of income for 2015.
The last I heard was that if someone was residing overseas they didn't have to worry about the penalty. That was last year though.
Mona writes that without subsidies, you're out of luck on costs in NYC. But she doesn't say that in 2014, NYS individual care premiums dropped 53%.
msf,
No I did not and with good reason.
"Good reason" - something else not stated.
I appreciate an interest in privacy. So in the absence of statements, I'll add a few. To the best of my recollection, in 2013 Empire Blue Cross (the Blue Cross branded insurance company covering NYC) offered only two plans to the general public.
One was a hospitalization only plan - no doctors, at a rate somewhere between $500 and $1K/month for a couple (no children). Didn't pay much attention to such a barebones plan. The other was a nice full coverage plan, at a "mere" $2200 or so per month for a couple.
Meanwhile Blue Cross was in the process of abandoning the NYC small business market. "In November of [2011] Empire ... announced plans to discontinue seven Small Group health insurance plans for its new York market. ... 20,000 companies, covering an estimated 250,000 workers and their families currently use any of the seven plans being eliminated by Empire. ... Under the revised announcement, persons enrolled in any of the seven discontinued plans will be covered through their plan's entirety and end at their previously-scheduled renewal dates." http://www.essexjobs.com/newsletter2/index.php/empire-blue-cross-blue-shield-will-discontinue-several-small-firm-health-insurance-plans/2012945/
That had nothing to do with ACA - the insurers didn't want to comply with NYS regulations (" failed negotiations with state regulators").
But what I will say is last year I had a fine underwritten Blue Cross plan that was very affordable. Now your President tells me my plan is not good enough for me, but his ACA plans are.
Three times the cost with half the benefits.
The NYC bronze rates for 2015 look similar to the small group rates that I was seeing in 2010-2011. (Level of coverage is another matter). That includes group plans from Oxford, HealthNet, and Empire.
(HealthNet was acquired in 2010 by UnitedHealthcare which also owns Oxford. But HealthNet was still marketed as a separate insurer during the transition period.)
Mona writes that without subsidies, you're out of luck on costs in NYC. But she doesn't say that in 2014, NYS individual care premiums dropped 53%.
msf,
No I did not and with good reason.
"Good reason" - something else not stated.
I appreciate an interest in privacy. So in the absence of statements, I'll add a few. To the best of my recollection, in 2013 Empire Blue Cross (the Blue Cross branded insurance company covering NYC) offered only two plans to the general public.
One was a hospitalization only plan - no doctors, at a rate somewhere between $500 and $1K/month for a couple (no children). Didn't pay much attention to such a barebones plan. The other was a nice full coverage plan, at a "mere" $2200 or so per month for a couple.
Meanwhile Blue Cross was in the process of abandoning the NYC small business market. "In November of [2011] Empire ... announced plans to discontinue seven Small Group health insurance plans for its new York market. ... 20,000 companies, covering an estimated 250,000 workers and their families currently use any of the seven plans being eliminated by Empire. ... Under the revised announcement, persons enrolled in any of the seven discontinued plans will be covered through their plan's entirety and end at their previously-scheduled renewal dates." http://www.essexjobs.com/newsletter2/index.php/empire-blue-cross-blue-shield-will-discontinue-several-small-firm-health-insurance-plans/2012945/
That had nothing to do with ACA - the insurers didn't want to comply with NYS regulations (" failed negotiations with state regulators").
But what I will say is last year I had a fine underwritten Blue Cross plan that was very affordable. Now your President tells me my plan is not good enough for me, but his ACA plans are.
Three times the cost with half the benefits.
The NYC bronze rates for 2015 look similar to the small group rates that I was seeing in 2010-2011. (Level of coverage is another matter). That includes group plans from Oxford, HealthNet, and Empire.
(HealthNet was acquired in 2010 by UnitedHealthcare which also owns Oxford. But HealthNet was still marketed as a separate insurer during the transition period.)
I will clarify.
There is no privacy issue, nothing is "not stated" and oh, I never said that I reside in NYC and I do not, so your examples are of no moment.
The facts are, last year I had a fine underwritten Blue Cross plan, that was very affordable, because I am healthy. Now your President tells me my plan is not good enough for me, but his ACA plans are.
I am now paying three times the cost and I have higher co-pays and a significantly higher yearly deductible.
@Mona- I'm curious as to the exact meaning and implications of "a fine underwritten Blue Cross plan". That phrase would seem to suggest that some entity other than you was contributing to the costs of the plan.
@Mona- I'm curious as to the exact meaning and implications of "a fine underwritten Blue Cross plan". That phrase would seem to suggest that some entity other than you was contributing to the costs of the plan.
It had reasonable doctor co-pays, for example, $30 for the internist and $50 for a specialist. For hospitalization, it had a $2,500 yearly deductible. I do not recall Rx because I take no medication. The plan met my needs and thus was "fine for me" and at a very affordable cost, which I paid 100%. My monthly premium was just under $225 per month.
It worked for Blue Cross, because I have a low risk medical history. It was a win/win for me and Blue Cross, but since it was non-ACA compliant, it did not work for others.
One other important point. What I had was a PPO, which afforded me the ability to go directly to any physician of my choosing. Now, for three times the cost, I get a metallic HMO and a gatekeeper. This means I have to pay the internist to get the referral to pay the specialist!
If you think I am one unhappy camper, you are more than right.
A few last points. First, I hope I provided enough clarity and transparency for msf. Second, I voted for your President in both elections. Third, I worked on the ground for his campaign in 2012.
As I reflect, I highly resent his lack of clarity and transparency. I think I am being kind using those words.
The $12,700 is for the healthcare plan. Everything in the dental plan, except 2 cleanings & standard xray, are out of pocket expenses for the 1st year of the plan. I don't recall the deductible for the dental plan, although it is higher compared to the previous plan with the same company; per my recollection.
Take care, Catch
@catch22, how much in dental expenses does the dental policy cover. In the past, they often had very limited coverage, for example, no coverage beyond say $1500 covered by the policy.
Mona, I discussed NYC because you specifically mentioned the location. As it turns out, rather than leaving people up a river without a paddle, ACA made health insurance twice as affordable as it had been previously. Perhaps that is to you an inadequate improvement, but it is a significant improvement nonetheless.
You added a complaint about HMOs requiring referrals that cost you extra money. While HMOs (but not EPOs) require referrals by definition, it is not inherent in HMOs that PCP visits/payments are required. Depending upon the situation and PCP, the PCP's office may just fax over a referral to the specialist's office upon your request.
There are few places outside of NYS where one cannot get PPOs. From NYTimes:
With no out-of-network coverage, “New York is a real outlier,” said Mr. Scherzer, who advocates more options. “But they did it in part because they thought it would keep premiums down, which of course it does,” he said.
Maybe you don't have access to PPOs, or maybe it's just that you found it better to receive "half the benefits" at "three times the cost" rather than all the benefits at, say, 5 times the cost. It's difficult to discuss the situation and tradeoffs without more information. I am not dismissing your cost/benefit concerns (since we don't know your options), but it does seem that you may not be limited to an HMO, cost aside. (Even in NYS, where many areas don't have PPOs, EPOs are still available - and those would address your cost-of-referral issue.)
Another observation from that NYTimes article - it is not ACA that's creating the dearth of PPOs in NYS - it's the NYS rules on top. So you may be pointing at the wrong culprit when you complain about being stuck with a gatekeeper. The point here is that there are a lot of moving pieces. Any particular attribute of the system could be due to a variety of different factors, objectives, regulations, etc. It's not as simple as "my cost went up."
From you statement that you had been getting a better rate because of your health, we may assume that you are not in one of the seven states that had community rating. Of the remaining 43 states, 42 had rates that varied at least 5:1 depending upon age.
ACA compresses this to no more than 3:1. That means that a good chunk of your rate increase could be due to your age, not your health. Over your lifetime, you may expect to benefit from this, by being charged less in later years. So this may be a reallocation of costs across time, rather than among individuals.
This is a complex system. You've presented a narrow window on your particular situation. What the full picture is, I don't know. And because of the large number of potential factors, I couldn't even tell you fully what my own picture is - it took me multiple conversations and research to understand why I was losing my group plan network.
Note - that complexity appears inherent in any insurance purchase - wait until you get to Medicare Part D (I'm nowhere close to that, but I have looked at the material and helped others with it).
Comments
Also to remember, there are doctors who graduate at or near the bottom of their class. How to find them? Good luck with that.
Therein lies a potentially huge problem.
With the exception of certain no cost "preventative" services, I believe the policyholder has to pay the full deductible before the policy covers any medical services.
Of course , perhaps due to cost, very few kids had orthodontics during my childhood years. Now it seems to be standard fare for braces or retainers. This part of dental health might take a hit.
The $12,700 is for the healthcare plan. Everything in the dental plan, except 2 cleanings & standard xray, are out of pocket expenses for the 1st year of the plan. I don't recall the deductible for the dental plan, although it is higher compared to the previous plan with the same company; per my recollection.
Take care,
Catch
If one is over 55 (probably younger) and under 65 and does not have an employer group plan (me), paid mostly by the employer, has a MAGI of $50,000 or greater (even living in NYC or SF), you are up a river without a paddle.
I am no longer part of the voting demographics that our government cares about.
Shut up and buck up. Period, end.
Mona
>> Private companies, who, as Accipiter pointed out, used the passage of the ACA to increase premiums.
Question: Is it not also the case that many have used ACA passage (used here meaning were forced) to decrease premiums? I read quite a bit about this too. You sound extremely orderly in your thinking, and so I wonder what you know about that too.
(Last summer, Krugman; I really wonder what if anything has changed:
"Last year there were many claims about “rate shock” from soaring insurance premiums. But last month the Department of Health and Human Services reported that among those receiving federal subsidies — the great majority of those signing up — the average net premium was only $82 a month.
"Yes, there are losers from Obamacare. If you’re young, healthy, and affluent enough that you don’t qualify for a subsidy (and don’t get insurance from your employer), your premium probably did rise. And if you’re rich enough to pay the extra taxes that finance those subsidies, you have taken a financial hit. But it’s telling that even reform’s opponents aren’t trying to highlight these stories. Instead, they keep looking for older, sicker, middle-class victims, and keep failing to find them.
"Oh, and according to Commonwealth, the overwhelming majority of the newly insured, including 74 percent of Republicans, are satisfied with their coverage."
One can work to slow the rise of costs (by increasing preventive care, by reducing the use of costly ERs as primary care facilities, etc.), and one can reallocate the costs across society. But that's about it, there is no magic bullet.
Insurance is one mechanism for reallocating costs - it spreads them more evenly, instead of people relying upon luck to avoid catastrophic costs.
All the anecdotes posted just illustrate that the country is going through a cost reallocation process. Not everyone is a winner. The hope is that for the most part, the winners are the ones who were those least likely to have gotten adequate care before.
The system in place now is far from ideal, but it is a reasonable attempt at providing greater levels of care - creating a healthier society overall and thus slowing the rise in the national cost of care.
I suspect that many people didn't really know the actual insurance costs. Employees tend to focus on just at their share; they see it go up a significant percentage, and feel cheated. They should - but that's because their employer is shifting a greater portion of the cost onto them. It used to be that at large companies at least, you'd get coverage 100% paid for by your employer, and those were better plans than they give you today.
Skeet commented that his Medicare Part C costs were doubling. But like employer coverage, that's a very small part of the cost of the plan. According to HHS, 80% of Medicare participants have access to a Medicare Advantage plan with $0 premium. (The true cost of these plans in 2013 was over $10,000.)
Mona writes that without subsidies, you're out of luck on costs in NYC. But she doesn't say that in 2014, NYS individual care premiums dropped 53%.
All of these represent reallocations of costs - employers paying a lesser share, more individuals in the pool (healthier individuals covering costs of less healthy ones), etc.
Because of ACA, I am about to lose a plan that had group rates, and a group network (ACA plans tend to have very small networks). And a plan that covered out-of-network expenses (it was a PPO). So I do understand what some people are experiencing - I'm one of them.
That doesn't make it a misguided attempt at improving healthcare coverage.
Thank you for your input to this topic.
You noted: "I suspect that many people didn't really know the actual insurance costs."
I agree wholly with this statement.
Both at our house received an annual report from our employer(s) with about 7-10 areas of costs/expenses related to our employment. One notation was the cost to the employer healthcare plan on an individual cost basis. I don't know how common such a report is; or whether this information is readily available at internal company web sites and/or via an HR department. So, we were always aware of the cost of the "benefit".
You also mentioned: "(ACA plans tend to have very small networks)."
I will update a portion of my previous stated information.
The one adult and minor child healthcare plans I noted are with BC/BS of Michigan.
The adult plan is named: Premier Bronze and the minor child plan is named, Premier Value. Lower deductible plans are available; although the monthly premium cost rises substanially. Both plans include very reasonable pricing for any meds/scripts.
New information: the deductible, for 2015; will move from the current $12,700 to $13,200, "to comply with federal law", as noted in the documentation from the plan provider.
The 2015 cost summary is: monthly premium to increase by 8.6% and the deductible amount burden on the plan holder with increase 3.9%.
Take care,
Catch
Yep, the govt is dictating every angle it appears.
Derf
Other than that, I agree with every single word @msf said. I think I'd just reiterate that the redistribution was always sort of happening anyway, it's just doing so in a far more transparent way now. The ACA -- as part of its whole "personal responsibility" bit -- now forces people to recognize that they are paying for others with their premiums and taxes, where before they didn't have to.
As a personal note, getting insurance outside of a university plan was always difficult for me due to existing health problems, so I'm pretty damn grateful to actually have insurance now without fear of denial from preexisting conditions. So hooray that.
as in "I worked for it", therefore someone else didn't "work for it" .
Was trying to avoid explicitly political terms. Which is why I refuse to use "Obamacare."
No I did not and with good reason.
But what I will say is last year I had a fine underwritten Blue Cross plan that was very affordable. Now your President tells me my plan is not good enough for me, but his ACA plans are.
Three times the cost with half the benefits.
I appreciate an interest in privacy. So in the absence of statements, I'll add a few. To the best of my recollection, in 2013 Empire Blue Cross (the Blue Cross branded insurance company covering NYC) offered only two plans to the general public.
One was a hospitalization only plan - no doctors, at a rate somewhere between $500 and $1K/month for a couple (no children). Didn't pay much attention to such a barebones plan. The other was a nice full coverage plan, at a "mere" $2200 or so per month for a couple.
Meanwhile Blue Cross was in the process of abandoning the NYC small business market. "In November of [2011] Empire ... announced plans to discontinue seven Small Group health insurance plans for its new York market. ... 20,000 companies, covering an estimated 250,000 workers and their families currently use any of the seven plans being eliminated by Empire. ... Under the revised announcement, persons enrolled in any of the seven discontinued plans will be covered through their plan's entirety and end at their previously-scheduled renewal dates."
http://www.essexjobs.com/newsletter2/index.php/empire-blue-cross-blue-shield-will-discontinue-several-small-firm-health-insurance-plans/2012945/
That had nothing to do with ACA - the insurers didn't want to comply with NYS regulations (" failed negotiations with state regulators").
NYS did not have a competitive marketplace prior to ACA. In 2009, monthly premiums for family POS plans in Manhattan ranged from $3500 to $6824.
http://pnhp.org/blog/2009/04/28/new-york-hmopos-death-spiral/ The NYC bronze rates for 2015 look similar to the small group rates that I was seeing in 2010-2011. (Level of coverage is another matter). That includes group plans from Oxford, HealthNet, and Empire.
(HealthNet was acquired in 2010 by UnitedHealthcare which also owns Oxford. But HealthNet was still marketed as a separate insurer during the transition period.)
http://www.dailyfinance.com/2014/11/20/if-you-thought-taxes-were-bad-this-year-just-wait/
Form 1040 draft
Form 1040 Instructions (draft)
If you are claiming an exemption from requirements, that's form 8965.
Form 8965 draft
Form 8965 Instructions (draft)
I will clarify.
There is no privacy issue, nothing is "not stated" and oh, I never said that I reside in NYC and I do not, so your examples are of no moment.
The facts are, last year I had a fine underwritten Blue Cross plan, that was very affordable, because I am healthy. Now your President tells me my plan is not good enough for me, but his ACA plans are.
I am now paying three times the cost and I have higher co-pays and a significantly higher yearly deductible.
Thanks for giving me the opportunity to clarify.
It worked for Blue Cross, because I have a low risk medical history. It was a win/win for me and Blue Cross, but since it was non-ACA compliant, it did not work for others.
One other important point. What I had was a PPO, which afforded me the ability to go directly to any physician of my choosing. Now, for three times the cost, I get a metallic HMO and a gatekeeper. This means I have to pay the internist to get the referral to pay the specialist!
If you think I am one unhappy camper, you are more than right.
A few last points. First, I hope I provided enough clarity and transparency for msf. Second, I voted for your President in both elections. Third, I worked on the ground for his campaign in 2012.
As I reflect, I highly resent his lack of clarity and transparency. I think I am being kind using those words.
Mona
The ACA is working. So why is the opposition to it so strong and persistent?
You added a complaint about HMOs requiring referrals that cost you extra money. While HMOs (but not EPOs) require referrals by definition, it is not inherent in HMOs that PCP visits/payments are required. Depending upon the situation and PCP, the PCP's office may just fax over a referral to the specialist's office upon your request.
There are few places outside of NYS where one cannot get PPOs. From NYTimes: Maybe you don't have access to PPOs, or maybe it's just that you found it better to receive "half the benefits" at "three times the cost" rather than all the benefits at, say, 5 times the cost. It's difficult to discuss the situation and tradeoffs without more information. I am not dismissing your cost/benefit concerns (since we don't know your options), but it does seem that you may not be limited to an HMO, cost aside. (Even in NYS, where many areas don't have PPOs, EPOs are still available - and those would address your cost-of-referral issue.)
Another observation from that NYTimes article - it is not ACA that's creating the dearth of PPOs in NYS - it's the NYS rules on top. So you may be pointing at the wrong culprit when you complain about being stuck with a gatekeeper. The point here is that there are a lot of moving pieces. Any particular attribute of the system could be due to a variety of different factors, objectives, regulations, etc. It's not as simple as "my cost went up."
From you statement that you had been getting a better rate because of your health, we may assume that you are not in one of the seven states that had community rating. Of the remaining 43 states, 42 had rates that varied at least 5:1 depending upon age.
ACA compresses this to no more than 3:1. That means that a good chunk of your rate increase could be due to your age, not your health. Over your lifetime, you may expect to benefit from this, by being charged less in later years. So this may be a reallocation of costs across time, rather than among individuals.
This is a complex system. You've presented a narrow window on your particular situation. What the full picture is, I don't know. And because of the large number of potential factors, I couldn't even tell you fully what my own picture is - it took me multiple conversations and research to understand why I was losing my group plan network.
Note - that complexity appears inherent in any insurance purchase - wait until you get to Medicare Part D (I'm nowhere close to that, but I have looked at the material and helped others with it).