[Pops]

So a factual thread about O-Care.
No spin, blog blah-blah, opinions etc; just Q or A from a reputable source.
Remember I'm just SGOTI so do your own research and correct whatever mistakes are posted by whomever.


> First, if you get insurance through your job, you need do nothing, most likely nothing will change for you.

--
If you don't have insurance (or have crappy insurance) because your job doesn't offer it or you are self-employed or unemployed or you've been excluded for a pre-existing condition or whatever reason, starting Oct. 1st Obamacare "exchanges" open online to help individuals and small biz buy coverage for the 2014 calendar year.
https://www.healthcare.gov/marketplace/individual/

The idea is there will be 4 standardized plans offered ("Bronze" thru "Platinum") by however many insurance companies care to participate in your state. So for example if you live in MO, you'll go to the link above and find your state's site where you can compare the prices offered by several insurance companies for the 4 different levels of coverage. This is cool because you'll be comparing apples to apples, all the "bronze" level plans will have the same minimum coverage, "silver"plans the same coverage etc. I assume companies are free to offer more than the minimums but have no idea if they will, it is a marketplace so with more transparency I'd think it's likely, we'll see.

---
You'll sign up for insurance online right through the same site, no insurance agents or doc exams, etc.

---
Here is the gov quiz to tell you what's in it for your particulars, whether you can/should participate, etc.
https://www.healthcare.gov/quick-answers/#step-1

---
If you make below a certain amount of income ($50k for 1 person, $65k for 2, etc), healthcare.gov is also where you'll find out if you get subsidised and sighn up for your handout. (sorry, lol)

---
Until october first when the actual plans go live online Kaiser has a tool to give you an idea of costs:
http://kff.org/interactive/subsidy-calculator/

--
I don't know but the reports I've heard is the cost of the plans being offered are coming in lower than expected so it may be worthwhile to check out the healthcare.gov site after the first of Oct if your plan at work isn't great or you pay a large percentage of the cost. Who know's it can't hurt.

--
Add whatever actual factual stuff about accessing the exchanges, subsidies, etc you think is important but don't go off on politics etc, I'll just delete it - start or find a thread for that, thanks.

.

[Pops]

OK, it was too much to ask anyone to start a new thread to spout their opinion so I did it.

Here is a thread for opinions, propaganda, politics, etc.

THIS thread is about how the exchanges work and how to work them. Lot's of people have no clue. Post questions and answers about how the exchanges or the law works or where to find info etc.

It's easier for me to simply delete your post than for you to write it, so either go the the other thread to blogivate and opinionize or don't whine when I delete your opinion here.

[Tanada]

Hey Pops, good thread. Do you have any data/graphs on the number of jobs being reworked to fit them under the 30 hour a week cut off? I believe the job I lost last year was replaced by two much younger workers each doing 24 hours a week but I can't prove it. Anecdotaly I hear much the same story from a lot of the unemployed.

[Newfie]

Ditto Pops, great thread idea, and I hope you are ruthless in culling the off topic BS, even if it comes from me.

Over on Cruisers Forum, about a year ago, someone tried to do the same thing, but got SLAMMED with opinion.

From the very little I know it will cost about $600 a month for a man and wife to have the insurance. But I don't have a clue what it covers, what the deductibles are and or what the geographic limitations are.

For example if you live in NJ but are visiting kids in CA and break a leg how does that work?
What about going out of country?
Do you have to get medivac insurance to get back to your home state to be covered?
Will there be reciprocity between states?

Thanks.

[AgentR11]

Something to note, that I've noted, is that with employer provided insurance, the medical history part of the app process is basically gone. This is a feature of the ending of pre-existing condition exclusion. People will also note that their insurer may occasionally send a note about how they've managed to spend 80% of collected premiums on customer benefits; again a change in the law; they have to refund the difference. This causes odd things like the insurance provider sending advertisements every once in a while to encourage the patients to SPEND MORE!!!! (not so blatant, of course, but funny none the less.)

Those are the two significant changes I've noted on the employer provided side.

I think that's pretty opinion free... It was kinda nice not having to type in my long, detailed, ocd list of medical history for the last app process I did.

[Pops]

The exchanges will go online next week but a whole lot of folks have no idea what is really going because of all the smoke and left/right blah-blah. I was hoping for one spin-free thread about how the ACA actually works is all, lol.

"Only one in four say they understand the law's impact on them and their families well while one-third say they have little or no understanding about how the law will work....
only half of those surveyed know there will be a health care exchange available in their state. Only half are aware that there will be federal subsidies for lower-income citizens to buy insurance."
Link

Not that anyone reading here is in that group but the nuts and bolts of what is expected and what is provided might be nice. And maybe when they go up, reviews of how the exchanges work, or not, and comments on the rates and plans, etc.

Reports on the crashes too, lol.
--
I don't know the answers about out of state or "network" stuff Newfie, I'd guess the plans offered will just be like any insurance plan except they will have the minimum coverages per the law.

Here I found this site about the levels, looks pretty neutral:
http://101.communitycatalyst.org/aca_pr ... rage_tiers

The four levels of coverage - bronze, silver, gold and platinum - are based on actuarial value, a measure of the level of financial protection a health insurance policy offers. It indicates the percentage of health costs that a health plan would pay for an average person. The four levels provided in the ACA are illustrated in the chart below.

The actuarial values for levels of coverage provided by qualified health plans



For a bronze plan, the insurance would cover 60 percent of all health care costs for an average person. Enrollees, on average, would be responsible for paying 40 percent of the costs. For a platinum plan, an average individual would pay 10 percent out-of-pocket for their covered benefits and the insurer would pay 90 percent. However, individuals with high-cost health conditions could end up paying significantly more than the average person.

--
AR, getting a note like that from an insurance co just might cause a few strokes in itself, lol

[dinopello]

Does Obamacare prohibit insurers from offering lower rates to non-smokers ? My company policy has a pretty significant discount for those who attest that they do not smoke.

[Pops]

Does Obamacare prohibit insurers from offering lower rates to non-smokers ? My company policy has a pretty significant discount for those who attest that they do not smoke.

A discount is the same as a penalty on the other hand and mostly I think the law discourages that. It comes back to encouraging more people to buy insurance, even if they are higher risk because one way or another society pays when they get sick.

From the same "101" site, tobacco use will still penalized:

Health plans will be allowed to adjust premiums based only on the following factors:
Individual vs. family enrollment (i.e., individual + spouse, individual + dependent(s), etc.)
Geographic area
Age (but cannot vary by more than three times among adults)
Tobacco use (the rate cannot vary by more than 1.5 to 1)

http://101.communitycatalyst.org/aca_pr ... g_premiums

[Loki]

Thanks for the thread Pops. America seems to be lost in a fugue state of disinformation when it comes to Obamacare.

Cover Oregon is the exchange site for Oregon. Based on their calculator, I'd pay $52/mo with a maximum $2083 out of pocket per year. This is based on the meager pennies I earned as a professional peasant last year. My employer does not offer health insurance (he doesn't even have any). I'm assuming this is for the "bronze" plan, but there's no mention of this on the Cover Oregon calculator.

It's also not clear to me exactly what this "out of pocket" maximum covers, though. Prescription drugs?

[Pops]

According to the same site linked above, the "out of pocket" is the same as "deductible":

Specifically, health plans will be prohibited from requiring consumers to pay annual cost-sharing that is greater than the limits for high deductible plans linked to health savings accounts. Currently, those limits are $5,950 per year for individuals and $11,900 per year for families. In addition, small group plans must limit deductibles to $2,000 for individual coverage and $4,000 for family coverage. As with all health plans under the ACA, there is no cost-sharing for certain preventive health services recommended by the United States Preventive Services Task Force.

The insurance cos are free to sell plans with lower deductibles

Here is a list of minimum coverage:

The essential health benefits are intended to mirror those provided under a typical employer-sponsored health plan. The HHS Secretary must define a package that includes, at a minimum:

Ambulatory patient services, such as doctor's visits and outpatient services
Emergency services
Hospitalization
Maternity and newborn care
Mental health and substance use disorder services, including behavioral health treatment
Prescription drugs
Rehabilitative and habilitative services and devices
Laboratory services
Preventive and wellness services and chronic disease management
Pediatric services, including oral and vision care

One of the benefits of standardizing the plans at least as far as minimums go is it makes choosing somewhat easier. I'd think the insurance cos will compete by adding coverage above the minimums as well as through low price, since they can't exclude people and services to profit and they can only make 20% OH%P now they have to go the Bigger Truck route.
Was that Opinion? lol

The HHS decides what is on the minimum list so it may say physical therapy for tennis elbow is covered, but only 5 visits.

[Newfie]

Thanks for the 101 site link. I've got some reading to do.

[Pops]

Thought I'd bump this up for anyone who tries to get on the site today. I tried around 6a and it was messed up and just now looked and got to the security question page before it stopped loading...

[AgentR11]

When you try to get in on the bleeding edge... there's typically bleeding involved!

From a factual pov, its hard to build an economically appropriate system that can also withstand an atypical, initial pulse of access. Just like the doors to walmart at the opening bell on the day after thanksgiving... In some ways its kinda weird though, I don't think you get a bonus prize for registering on the ACA exchanges on the first day.

[Pops]

prolly all the blogovators and punditizers trying to get a story, lol

[Loki]

Coveroregon.com loaded quickly, so not overloaded. Didn't try to sign up. Coverage doesn't start until Jan 1, 2014. I generally try to put off paperwork until the last minute, or usually, several minutes afterward.

[Keith_McClary]

Seems awfully complicated. Why can't the US have a simple system where you go to the doctor and the doctor sends the bill to the gubmint? They do that here. The gubmint annually sends us out a list of payments to our doctors, just to keep the doctors honest.

[AgentR11]

Seems awfully complicated. Why can't the US have a simple system where you go to the doctor and the doctor sends the bill to the gubmint? They do that here. The gubmint annually sends us out a list of payments to our doctors, just to keep the doctors honest.

I think the answer to this question goes in the political one; as it is opinion.... posting my answer there.

[Sixstrings]

Read in my local paper that one plan, I forget what level if it was bronze or what, would cost $380 a month for an individual earning up to $47,600 a year.

That $380 would get government subsidies according to your income, so even if you're making 47k you'd still get some subsidy. Someone making 25 or 30k would presumably get a much larger subsidy.

That's all the details I know about it. Seems fair -- even at 47k, someone could afford $380 a month without subsidy. This all sounds comparable to kid's insurance type state programs that people already pay for.

This could wind up working out pretty well. No more pre-existing conditions problems. No more astronomical prices for non-employer insurance.

Also, insurance companies have really tooled up for the exchanges. I saw an interview with a Blue Florida rep, he said they're going to open retail health centers offering their plans in the Obamacare exchange, and also have nurses to do some basic screening and care -- now that's common sense, that's some progress, that's private industry at work figuring out how to make a profit under smart guidelines set by government.

Something as simple as that, a nurse available to policyholders to go see, saves everyone money versus a $5,000 trip to the ER that the person can't and won't ever pay.

(hope I didn't drift too much into opinion)

[Pops]

Well, I finally was able to create an account. This is through the fed website, MO is ignoring the whole thing.

So now I need to provide verification of my income - for 2014.

And proof of my wife's citizenship...

the page crashed uploading a tax return from 2012.

Lots of glitches, failure-to-load dropdowns, "not-authorised" errors, "ID" error whatever that is and of course "Please Hold" sans Muzak. If you aren't just really curious I'd suggest waiting a while. Kind of disappointing, I expected delays but not malfunctions.

On the upside the DB did recognize me, knew the vehicle I drive, the employer's name on the last W2 I recieved 10 years ago and that I haven't shaved this morning. I was kinda surprised it acted like verifying my income for 2014 via W2s, check stubs or tax returns was routine, especially when I'm self-employed, LOL. I assumed it would look at past IRS data and if it was near my income forecast for 2014 it would be close enough for government work. Not sure what benefit there is to me sending in a PDF of a form from 2012 when the IRS already has it on file.

For folks not used to computers and the 'net, they're gonna need help so this is definitely not a job killer for insurance agents. LOL

[Sixstrings]

Well, I finally was able to create an account.

Did you get a look at the plans yet? Would you want to post about the cost and details? It'll be different from state to state, of course.

As for all those site crashes, according to the Romney model in MA everyone signs up right away or at the end of open enrollment. So if people can't get through right away, just wait a couple weeks and should be smooth sailing I'd guess.