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Thread: Professional Woodworkers and The Affordable Care Act

  1. #31
    Join Date
    Oct 2013
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    Northwest Indiana
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    I'm quite impressed with several things about this thread...
    1. The civil tone of the discussion--if we'd get the same behavior from both sides of "The Aisle" (and from the media), we'd have a better solution in place already.
    2. The general knowledge of the group--even the MLR (medical loss rebate) difference between small group (<50 ee's, 80%) and large group (85%). A lot of insurance people don't know that--and there are a very small percentage who know how to help an employer calculate the distribution!! (okay, i'm one who can...and i'm proud of our agency for being committed to training and technology)
    3. The opportunity to hear from consumers who have taken the time and effort to arm themselves with information.
    4. That folks among this group would understand WHY many plans needed to be cancelled. No requirement to cancel them, but it's almost impossible to be effective in filing for so many amendments on existing plans.

    I would caution that while we may see some very recognizable insurance company names in our respective exchanges, but the provider networks have tended to be much smaller than what we've come to expect. I'd expect the retail (non-exchange) networks to narrow as well, but those will usually be broader. Just know that seeing a name that you've known to have a huge network--carefully look at the network they are offering for the plan you consider. (those of us who need to see a specialist or might want to visit an emergency room in a different state for a non-life threatening emergency might want to be especially careful--think 10 stitches for a foot cut on a beach in Florida billed at $4,000 with no coverage to help).

    Someone suggested selecting an agent who has sought education on the topic--wise advise. I am greatly impressed with some of our competitors in our area, and with many of the folks that are in my online study groups. At the same time--i'm equally embarrassed for my industry when I listen in to some of the Q & A sessions on webinars--it's simply sad. It's not a time to "sell" health insurance, it's an opportunity to provide the most valuable service that we could have imagined--and far too many "agents" have squandered that chance.

    Thanks to all for keeping it peaceful--be careful out there!!
    earl

  2. #32
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    Sep 2007
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    Upstate NY
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    Quote Originally Posted by Earl McLain View Post

    Someone suggested selecting an agent who has sought education on the topic--wise advise. I am greatly impressed with some of our competitors in our area,
    That isn't my experience. I gotten 7 contradictory answers to what I thought was a simple question. I didn't think there could be 7 contradictory answers.

    Don't they have to cover out of network emergency care? (ie. the 10 stitches in Florida)

  3. #33
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    Deep South
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    As far as I know, there are only two ways to control costs on health care - or anything else for that matter. They are (1) price controls and (2) competition. Most of the initiatives to control Medicare costs have been of the first type. This method has some very undesirable consequences. Where I live, many of the doctors no longer accept Medicare patients because the level of compensation is insufficient to cover costs. I have heard proposals to force doctors to accept Medicare patients but this will lead to other undesirable consequences. First of all, the level and quality of care will go way down as doctors turn their offices into high speed patient treatment mills. Secondly, a lot of doctors will simply retire. Finally, fewer people will choose to become doctors because the cost of entry is too great for reduced compensation. Many locations already don't have enough primary care physicians and the situation could get worse - much worse.

    The other method of cost control, competition, has not been in effect in the US in several decades. The reason is that there is no connection between the person receiving the treatment and the person paying the bill. That is the nature of the current health insurance industry. Why should I, as a consumer, try to minimize treatment costs if the amount I pay is always a fixed deductible? The company I retired from initiated a program in which they raise my deductibles, which saves them money, but give me a substantial cash sum of money for health care expenses. If I exercise my own discretion to control treatment costs, I get to keep that money for health care expenses in future years. I now have a strong motivation to minimize my costs. Apparently, my company is happy with the arrangement as it has been in place for a while now and I am happy because I am accumulating cash in a medical savings account to use when I really need it. I wish the government would adopt such a program.

  4. #34
    Join Date
    Oct 2006
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    Minneapolis, MN
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    Many employer health plans now require employees to pay 20% or more of the cost of any medical care up to a yearly maximum on out of pocket costs. There is still the problem of nobody knowing how much the care will cost before using it. My employer requires I pay 20% of whatever amount the insurer has negotiated with the provider up to yearly max of around $3,000.

    My employer also offers an HSA plan, but the deductible goes from $250 to $2600 for an individual and the company puts $800 into the HSA. The HSA plan really only makes sense for someone who is very healthy and never uses medical care.
    Last edited by Brian Elfert; 11-08-2013 at 11:12 AM.

  5. #35
    Quote Originally Posted by Brian Elfert View Post
    Many employer health plans now require employees to pay 20% or more of the cost of any medical care up to a yearly maximum on out of pocket costs. There is still the problem of nobody knowing how much the care will cost before using it. My employer requires I pay 20% of whatever amount the insurer has negotiated with the provider up to yearly max of around $3,000.

    My employer also offers an HSA plan, but the deductible goes from $250 to $2600 for an individual and the company puts $800 into the HSA. The HSA plan really only makes sense for someone who is very healthy and never uses medical care.
    High deductible plans also make sense for people who have high normal costs for healthcare if they are of the type that offers a high deductible but 100% compensation for covered services after the deductible is met. It's the folks who use moderately that don't win with that model, though. The most important thing to me as an insured is not necessarily the deductible, but clear communication of what's covered and what's not, and most importantly, the annual out of pocket limit on covered services.

    I would love to see greater specification of costs up front as Art says, but if it was really easy to do, we would already see it. It would be nice to see it implemented a little at a time for services that are easy to specify. Right now, you can do legwork and call around and get prices in some cases, and get individual agreements on the price. Insurers are aware of that, too, and in my case, I get emails from the insurer (and I'm sure others do, too) that offer to find members the least expensive place to get imaging, etc, done. In my case, once i've met my deductible, that only matters on principle, but if I had a 20% copay, after a few scans, that can amount to several hundred dollars of copay.

  6. #36
    Join Date
    Mar 2010
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    SE Michigan
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    Quote Originally Posted by Brian Elfert View Post
    The HSA plan really only makes sense for someone who is very healthy and never uses medical care.
    I can only compare to my retiree health care plan (pre-Medicare) and it's the exact opposite when you take the monthly premiums into account. The PPO plan (i.e., 20% co-pay, $0 deductible) doesn't beat the HSA plan until you have approx. $3800 in medical bills accrued annually. Up to $3000 in bills, the out-of-pocket cost for the PPO plan is actually $500 worse.

    You need to also remember the funds you put into an HSA account are tax-deductible if you itemize (up to a certain amount depending upon your coverage, individual, +spouse, + family, etc.).
    "Don't worry. They couldn't possibly hit us from that dist...."

  7. #37
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    Oct 2006
    Location
    Minneapolis, MN
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    On our HSA plan for an individual the deductible is $2600 and the maximum out of pocket is $3500 including deductible. Our HSA plan covers 90% once the deductible is satisfied. Basically, one would need to have $11,600 in non-preventative medical expenses before the plan would cover 100% of all costs. Preventive care, including prenatal and postnatal, is covered 100% with no deductible.

  8. #38
    Join Date
    Jan 2004
    Location
    Lewiston, Idaho
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    I want to again....thank everyone for keeping the subject to information......and request that we keep personal opinions out of this. Personal opinions quickly turn to political statements.

    Again...thanks for keeping on subject......and away from political comments.
    Ken

    So much to learn, so little time.....

  9. #39
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    Oct 2006
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    Minneapolis, MN
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    Quote Originally Posted by Bob Turkovich View Post
    I can only compare to my retiree health care plan (pre-Medicare) and it's the exact opposite when you take the monthly premiums into account. The PPO plan (i.e., 20% co-pay, $0 deductible) doesn't beat the HSA plan until you have approx. $3800 in medical bills accrued annually. Up to $3000 in bills, the out-of-pocket cost for the PPO plan is actually $500 worse.
    I do not use the HSA plan today. My health care claims so far for the year are $3,400. My out of pocket cost is $1040 so far this year. I will pay $1,440 for my share of my health insurance plan. My total cost for medical care for the year will be right around $2,500 if I don't need more care.

    If I used the HSA plan my claims would still be $3,400. My out of pocket cost would increase to $1,880. I would pay $1,224 for my share of my health insurance. My total cost for medical care for the year would be right around $3,100. I took into account the $800 the company puts into the HSA.

    This is a good exercise to do as open enrollment is right now. For me this year, HSA would have cost me $600 more than the traditional medical plan and I have fairly low medical expenses. HSA plans can be set up all different ways and might make sense for some. I didn't include after-tax versus before-tax as that would be almost impossible to calculate.
    Last edited by Brian Elfert; 11-08-2013 at 1:40 PM. Reason: Added missing words to one sentence.

  10. #40
    Join Date
    Jan 2008
    Location
    Western Nebraska
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    4,680
    Because the conversation went to HSA's, I'm curious if anyone else feels the same as me. I want a simple, high deductible, no copay policy. I use it as a major medical plan. I also like HSA because of the tax benefits and the ease of applying little things to the larger deductible. For me, our $5,000 per family deductible HSA plan came out to much lower out of pocket per year than anything else out there, as calculated by premium plus total out of pocket costs. We're not that old, not having any more kids, and mostly healthy though, so it's probably different for others. I liked it because I knew exactly how much medical would cost me no matter what. That is the plan I lost, question is, is anyone else looking for that type of solution?

  11. #41
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    Feb 2003
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    Quote Originally Posted by Paul Wunder View Post
    In Connecticut, the networks are limited to the state of Connecticut.
    It would seem in smaller states, or for people who work and live in different states (how many folks living in Connecticut work in NY, and have doctors in NY, etc....) this could be a big problem.
    It came to pass...
    "Curiosity is the ultimate power tool." - Roy Underhill
    The road IS the destination.

  12. #42
    Join Date
    Jul 2007
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    CT
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    Quote Originally Posted by John Sanford View Post
    It would seem in smaller states, or for people who work and live in different states (how many folks living in Connecticut work in NY, and have doctors in NY, etc....) this could be a big problem.
    It certainly came as a surprise to me....and it most certainly must affect thousands of people who border NY from Connecticut or who just need the special skills of New York hospitals. But as I previously mentioned, CT is blessed with a number of nationally ranked hospitals. It does concern me that people in less populated states may have fewer choices.

    One of the major advantages of Medicare is that a person can obtain care anywhere in the U.S. Most hospitals accept Medicare and most NYC metropolitan area Physicians do too. I am fortunate to be covered by Medicare so that this first iteration of the AFA Exchanges does not affect me.

  13. #43
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    Quote Originally Posted by David Weaver View Post
    Or renal failure. The biggest claims I've ever seen in annual data are related to renal failure.
    Dialysis is expensive, and also effective. Which, from a pure bean counters perspective, is a bad thing. The patient just keeps on keepin' on, and needs dialysis routinely, because IIRC most folks who go on dialysis don't come off it until they shuffle off this mortal coil. While dialysis has, from the individual treatment standpoint, gotten less expensive over time, as well as become more effective, it has become more expensive per patient over time because the patient longevity has gone up faster than the cost has gone down.

    This sort of dynamic has played out across a wide range of medical treatments, which is one of the reasons for the increase in medical costs. Put simply, our health care abilities have gotten all the low hanging fruit, and from a cost standpoint we are into the realm of 20%/80%, where 20% of the care consumes 80% of the cost.

    There's no free lunch, but there is a case where your lunch is bigger than mine and you give me some food, at least that's how I'd describe it.
    "give" is not the term that many would use.

    From a practical standpoint, I question why they would use ZIP in HEALTH risk assessment. Age, sex, and tobacco use all make some sense. ZIP though? Not really, unless it's basically a form of reverse redlining, i.e., charge higher rates in the wealthier ZIP codes in order to mask subsidy collection.
    It came to pass...
    "Curiosity is the ultimate power tool." - Roy Underhill
    The road IS the destination.

  14. #44
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    Quote Originally Posted by Paul Wunder View Post
    It does concern me that people in less populated states may have fewer choices.
    Well, for many of the less populated states, it may not make much difference. Out West, the less populated states face the problem of distance, not legal boundary. For the vast majority of people who live in Montana, restricting their network to just Montana isn't likely to change much. Rhode Island and Delaware, on the other hand, can easily be getting hosed by this, especially RI, which, based on my understanding of their economic situation, isn't in nearly the fine position you've described for Connecticut. Rationally speaking, why should they be? Connecticut and Mass. are right next door, with their world class medical facilities. In the same vein, if one has lived in NW Indiana their entire life, why sweat it that Gary doesn't have any top tier medical facilities? Chicago is right next door.

    This is actually has the potential to be a huge problem for a significant part of the population. By court order, millions of non-custodial parents are required to provide health insurance for their children. Previously, many policies supported networks that would spill over into border regions of adjoining states. Now what?

    One of the major advantages of Medicare is that a person can obtain care anywhere in the U.S. Most hospitals accept Medicare and most NYC metropolitan area Physicians do too. I am fortunate to be covered by Medicare so that this first iteration of the AFA Exchanges does not affect me.
    Yes, but not only is Medicare age restricted, it's also, apparently, becoming less popular with health care providers, a trend that shows no sign of reversing.
    It came to pass...
    "Curiosity is the ultimate power tool." - Roy Underhill
    The road IS the destination.

  15. #45
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    Quote Originally Posted by John Sanford View Post
    From a practical standpoint, I question why they would use ZIP in HEALTH risk assessment.
    Profiling, maybe? I imagine areas heavy with drug use, violence, etc. would be more costly on the healthcare scale...
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