How Insurers Are Hiding Obamacare Benefits From Customers

[dank69]

I have yet to find insurance cheaper than my current rates, which just happened to go up 9% last month.

First time your rates have ever gone up, I'm sure. Damn you ACA!

As long as he lives in his moms basement he has nothing to worry about.

While the rest of us are struggling to get by, dank is probably munching on hot pockets and playing world of warcraft.

This guy thinks you have a weak mind:

Insults are the last resort of a weak mind.

...

 

[Matt1970]

Yes, yes, just like Benghazi was a disaster. It's just been one disaster after another and yet polling for Republicans has been tanking. Sucks to be you.

So you really think after taking hundreds of dollars extra out of people's pockets every month for the next year after lying to them repeatedly that people will still be angry about the shutdown?

 

[Texashiker]

First time your rates have ever gone up, I'm sure. Damn you ACA!

The going rate is around 2.5% - 3% per year and usually in January.

This year my rates went up 9%, and I will have to wait until January to see if they go up again.

If my rates go in January like they have for the past 20 years, that will be a 12% increase in 3 months.

 

[Matt1970]

Right, forcing companies to list the prices and services of each of their plans side by side on a single page for the consumer to easily compare them doesn't force the companies to compete at all.

Difference is people are forced to purchase their product. That's why the rates seem to be going up, not down.

 

[Matt1970]

First time your rates have ever gone up, I'm sure. Damn you ACA!

Obama as a business owner:

Obama: Come in my store. I promise you all my prices have gone down.
Customer: Hey, you lied, your prices went up!!!
Obama: Is this the first time you have ever seen prices go up? Besides, they didn't go up that much.

 

[sactoking]

The article is misleading, probably because the author doesn't understand the topic. It's written under the assumption that insurers are voluntarily sending cancelation notices, finding comparable plans, and purposely obfuscating the existince of the exchnages and tax credits. That assumption is wrong.

The National Association of Insurance Commissioners (NAIC) has promulgated model law regarding guaranteed renewability of insurance. In states that have adopted this model (like my own), insurers must renew a plan at the option of the insured with 4 basic exceptions:
1. failure to pay a premium;
2. fraud or material misrepresentation;
3. the insurer is withdrawing from the market; or
4. the product offered is obsolete.

This NAIC model law is what the ACA's guaranteed renewability provision is modeled after.

We have a problem though: if a plan isn't ACA-compliant, how do you remove it from the marketplace without violating your existing guaranteed renewability law? The answer the states came up with was to declare the existing policies to be obsolete.

When a plan is declared obsolete the insurer generally has to do three things:
1. inform the state DOI;
2. inform the consumer; and
3. offer the consumer the chance to purchase any other plan offered in the state by the insurer.

You'll notice under provision 3 that the offer need only be the plans offered by that insurer. You'll also note that the ACA prohibits consumers from receiving tax credits if they sign up for a plan in any manner other than through an exchange, including directly with an insurer.

There's nothing nefarious going on here by insurers to "hide" anything, they're fulfilling their legal obligation to notify consumers of an obsolesence and move them over to another plan offered by that insurer.

 

[theeedude]

http://www.newrepublic.com/article/115457/obamacare-victim-florida-happy-she-can-get-real-coverage

Another so called "Victim" says she'd jump on an Obamacare plan. I don't blame her:

The policy Barrette has today is called the Go Blue Plan 91. It is not what most people would consider real insurance. Its coverage of doctor visits and tests, such as MRI scans, consists of paying $50 and then letting Barrette pay the remaining balance. Drug coverage works more or less in the same way, only the plan pays $15 per prescription—which is enough to cover generics, but not many name-brands. And hospitalization? The plan pays nothing at all.

It's basically the opposite of what insurance should be. It's like fire insurance that only covered smoke detector battery replacements.

 

[Texashiker]

And hospitalization? The plan pays nothing at all.

Holy crap, is that what people are calling "real insurance?"

 

[berzerker60]

Holy crap, is that what people are calling "real insurance?"

Honestly I think a lot of the angst and unhappiness that's getting stirred up in this issue is based on people paying attention for the first time to how spectacularly fucked up the American health care system really is/was. Whatever your take on Obamacare, American health care is and was broken as as hell (unless you were well off and/or lucky, but for most people).

Here's a former Cigna exec talking about these plans: http://www.publicintegrity.org/2013...re-outlaws-policies-are-essentially-worthless
Plans specifically designed to never pay out anything, just profit off of people not getting any health care they don't pay for our of pocket.

Honestly it astounds me that the business community doesn't lobby in favor of reforming all this crap towards single-payer - even at the cost of increased taxes, they would make a killing by having healthy, productive employees who don't cost a dime in terms of health care coverage. But actually that's not true, it makes perfect sense: right now, they have more power over their employees because losing your job also loses your health care, so employees are in a weaker bargaining position.

 

[sactoking]

http://www.newrepublic.com/article/115457/obamacare-victim-florida-happy-she-can-get-real-coverage

Another so called "Victim" says she'd jump on an Obamacare plan. I don't blame her:

It's basically the opposite of what insurance should be. It's like fire insurance that only covered smoke detector battery replacements.

That's because it's not insurance, it's a medical discount plan.

 

[Gonad the Barbarian]

...There's nothing nefarious going on here by insurers to "hide" anything...

The Kentucky Department of Insurance has fined Humana $65,430 because it offered policyholders an unapproved opportunity to amend their insurance as part of a letter that regulators have called “misleading.”

The department investigated letters sent in August to 6,543 individual plan policyholders in Kentucky. The letters said they needed to renew their plans for 2014 within 30 days or choose a more expensive option that complies with the Affordable Care Act.

But regulators last month called the letters misleading, arguing they did not make sufficiently clear that policyholders could compare and choose competing plans on the state’s health insurance exchanges, which open on Oct. 1, and for which they could be eligible for federal subsidies.

Humana's letter mentioned the exchange enrollment period, but only in a footnote. It also said a customer can get the cheaper premium option by agreeing to changes that hadn’t been approved by the state insurance department.

While the investigation continues into whether the letter was intentionally misleading, state officials said, the department fined Humana on Sept 10 for the unapproved amendment that “caused confusion” among policyholders. An estimated 2,200 returned signed amendments, it said.

“The Department of Insurance fined Humana for providing members with a policy amendment form that was not approved. This was a clear-cut violation of Kentucky’s insurance code,” said Sharon Clark, Insurance Department commissioner.

“The Department has other concerns with the letter and with Humana’s actions. We have met with Humana and continue our investigation. We will take additional administrative action, if appropriate,” she said.

Clark has previously said she considered the letter “misleading intentionally.”

Humana spokeswoman Kate Marx said Tuesday that the company “is working in concert with the state Department of Insurance. Humana does not plan to appeal the decision.”

State insurance officials say that Humana has told them they would send a clarification to those who had gotten the letter in question.

http://www.courier-journal.com/apps/pbcs.dll/article?AID=2013309240089&nclick_check=1

 

[Gonad the Barbarian]

Except the ACA limits how much profit health insurance companies can make.

No no no, that shall not be mentioned while there's outrage to be stoked.

Honestly I think a lot of the angst and unhappiness that's getting stirred up in this issue is based on people paying attention for the first time to how spectacularly fucked up the American health care system really is/was. Whatever your take on Obamacare, American health care is and was broken as as hell (unless you were well off and/or lucky, but for most people).

Truth.

 

[theeedude]

Honestly it astounds me that the business community doesn't lobby in favor of reforming all this crap towards single-payer - even at the cost of increased taxes, they would make a killing by having healthy, productive employees who don't cost a dime in terms of health care coverage. But actually that's not true, it makes perfect sense: right now, they have more power over their employees because losing your job also loses your health care, so employees are in a weaker bargaining position.

This, and also the fact that they can outsource employees or not provide them with insurance at all.

 

[sactoking]

http://www.courier-journal.com/apps/pbcs.dll/article?AID=2013309240089&nclick_check=1

That's not the same thing. The original discussion was about insurers sending cancelation notices. That's an early renewal, and the underlying issue is that they were offering an unapproved form. It's a fine distinction for those not in the industry, but it is a difference with vastly different legal ramifications.

 

[sactoking]

Except the ACA limits how much profit health insurance companies can make.

That's a point-of-view thing. Yes, the ACA limits profit, but it does so as a % of premium. It does nt actually do anything to limit profit because as premium goes up so does profit. There is a "rate review" provision that's intended to keep premium increases in line but it's effectiveness is yet to be seen. (Generally speaking, a rate is reasonable so long as the assumptions behind the rate are reasonable. In order to disapprove of a rate the regulatory agency has the burden of proving an assumption to be unreasonable.)

 

[OverVolt]

Wrong again. If 10 different companies can sell you dog shit, they have to compete with each other on price. You would only have a point if there was only one health insurance company. There isn't one health insurance company, so therefore, you are a retard.

The insurance companies aren't the ones with any power. Auto insurance is such a good example. You aren't charged $5,000 for a tire because there is only one tire transplant facility for 500 miles, but that is the way healthcare works.

In a situation like that its actually the mechanics/autoshop that make out and no matter how much you force the insurance companies to compete with each other prices are not going to come down. Because part of the insurance policy is always that 1% chance they may have to pay out for the monopolized procedures.

So they'll compete on copay's or whatever, going to the doc is $5 oh gee whiz thats real fantastic when you're already paying out the nose every month. The doctor isn't the expensive part its the accidents, diseases, etc that need expensive treatment.

 

[EagleKeeper]

This, and also the fact that they can outsource employees or not provide them with insurance at all.

Is the outsource agency required to then provide the insurance?
If they pay on a W2 basis; the person is an employee

 

[EagleKeeper]

Except the ACA limits how much profit health insurance companies can make.

Profit as a percentage of premiums less expenses.
If Premiums go up; they can increase expenses paid and also then increase the amount of profit.

5% of 1000 is much less than 5% of 2000.

So there is an incentive for higher premiums. They can then not squeeze the doctors so much and still make a larger profit.

 

[OverVolt]

http://www.familiesusa.org/assets/pdfs/no-bargain-medicare-drug.pdf

Page 4 and 5 right. That is what happened to prices when medicare was no longer allowed to negotiate on prescription prices as part of Medicare part D.

Insurance companies do a bad job of negotiating prices. The ACA is just throwing money at the problem. Subsidized money.

 

[Tom]

Are states going to establish a government agency to control health insurance rates, like what they do for car insurance, home insurance, electric rates, gas rates,,,,, etc?

I'm pretty sure states were doing that before Obamacare, not sure if it's continuing.

There are things in Obamacare to try and control costs and increase competition. Whether they will work is up for debate.

For example, insurance companies are limited to, I think 7%, for overhead costs. So in theory they're limited in what they can charge.

And there's some sort of new not for profit entity that's supposed to provide competition for private insurers, although I think those are having troubles getting going.

 

[Tom]

That's not the same thing. The original discussion was about insurers sending cancelation notices. That's an early renewal, and the underlying issue is that they were offering an unapproved form. It's a fine distinction for those not in the industry, but it is a difference with vastly different legal ramifications.

The "model legislation" you're talking about, what are the proposed dates ?

People should not be forced to decide what insurance they want to purchase until they have all of the options in front of them. That would include information they have to get from the new exchanges.

It sounds like the insurance companies are trying to keep their current customers from being able to partake of new options by getting them locked into new policies before they can see what choices they might have.

Tell me why I shouldn't see it that way ?

 

[Fern]

What does any of that have to do with your assertion that the ACA reduces competition when it actually increases competition?

Look up North Carolina. I can't see where it has improved competition one bit. Most of our counties have exactly one option on the HC exchange. IIRC, about a third of the counties include a (small) second provider. That it's as best as I can tell.

Fern

 

[sactoking]

The "model legislation" you're talking about, what are the proposed dates ?

People should not be forced to decide what insurance they want to purchase until they have all of the options in front of them. That would include information they have to get from the new exchanges.

It sounds like the insurance companies are trying to keep their current customers from being able to partake of new options by getting them locked into new policies before they can see what choices they might have.

Tell me why I shouldn't see it that way ?

I don't have the NAIC model law date (the NAIC's website is an abomination) but I know that we adopted it as Nevada Revised Statute 689A.630 in 1997 and it remained unchanged until this year when we had it amended to refer to "geographic service area" in subsection 5 instead of "established geographic service area."

The insurers may want to lock people into new policies but that desire is not relevant so long as they follow the law in regards to obsolesence, which it sounds like they are. (It's not relevant b/c obsolesence requires moving insureds into comparable policies, which is what the insurers' desire may have been anyway.)

 

[Fern]

Originally Posted by Hayabusa Rider
You dont have a job do you

Why would you ask that? Because I don't give corporations a pass when they fuck the consumer in the persuit of the almighty dollar? Or when they fuck their employees for the same reason?

Because if you have a job you should have already received a letter explaining the HC exchange etc. The letter was required of employers with only one employee, and whether or not the employer provides a HC plan. The letter was due to be issued by Oct 1.

The point being this woman couldn't reasonably claim to be unaware of the HC exchanges etc even if she didn't have a TV, internet or read newspapers.

Fern

 

[Gonad the Barbarian]

Look up North Carolina. I can't see where it has improved competition one bit. Most of our counties have exactly one option on the HC exchange. IIRC, about a third of the counties include a (small) second provider. That it's as best as I can tell.

Fern

BCBS has always had NC locked up as pretty much the sole individual provider. I had no idea Coventry even existed before the exchange.