Just for fun, let's start at the beginning. The Alpha of New York Health Insurance Exchanges:
Here is a link to the New York State of Health website: New York Health exchanges!
Here is a link to the basic plan for each precious metal category: Basic plans
Here is a link to the premium and subsidy estimator: Tax Credit and Premium Estimator [Look hard and you will find it. There is a link at about the middle of the page. Yeah, right there so small you'd miss it if you weren't looking for it.]
Now if you've made it THIS far, here is a link to the insurance providers that are available in each county: Insurance Providers by County
Last week, there was a link to a lovely EXCEL spreadsheet that had links to all of the providers and even sometimes the providers had basic information about what each of their plans provided, but that seems to have disappeared.
The bottom line is that there is no one place where you can get information on plans (deductibles, out-of-pockets etc) and premiums in the same place. I tried to develop my own spreadsheet that married the premium ranges with the basic plans, but it was becoming a full-time job, so I gave up. I am not sure why this is supposed to be such a chore. I am worn out and I am not even signing up!
Here are some basic premium ranges and plans for the "silver" plans which are supposed to be the plan one has to buy to receive any subsidies:
For a single person living in Manhattan with a yearly income of $45,000, there are nine "silver" plans from which to choose with monthly premiums that range from $360 to $645 minus $9 monthly advance subsidy. Each plan has a deductible of $2000 plus $5,500 out-of-pocket expenses and $30-$150 co-pays.I can see why they are trying very hard to keep this all a big secret for as long as possible. For someone living in Manhattan who is earning $45,000, that is NOT any great bargain. Andrew quoted that upwards of 80K people have signed up in New York, however it has been reported in the local papers that 40K have signed up. I have a sneaking suspicion that the high number includes people who have "created an account" which does not mean one has actually purchased insurance yet.
Upstate New York in Onondaga County, there are five plans with monthly premiums that range from $285 to $462 (no subsidy) which presumably have the same deductible/out-of-pocket expenses/co-pays.
Anyway, play around with the estimators and find out how much you would pay if you live in New York. Have fun, but not TOO much fun!
Bev, What a mess! And yeah, no wonder they want to keep people from figuring this out. That is not "affordable."
ReplyDeleteAlso, I have recently learned that the "out of pocket" costs are indeed separate from the deductible. So you pay the deductible and then X% up to the out of pocket cost. That seems to be around $7k to $12k for individuals and more than double that for families.
On the numbers who signed up, I also think they are counting the number of people who created an account. They could also be counting new Medicaid people in the numbers. I understand that some states are routing those people through their websites to make the number seem higher.
"coverage first" was always the mantra of the Obama Care forces. Hence the design of the system to get people's information first, see if they qualified for subsidies, and hide the actual cost. I have been around corporations long enough to see through the quality control process that was made part of the law. They might as well have just said "we will work harder, not smarter." Still, while people overwhelmingly dislike Obama Care, they trust Democrats with their health care more than Republicans, so I don't see this as helping. Avik Roy does get it. The way to defeat Obama Care is by offering a more affordable solution. He has a plan A and Plan B on legislation depending on what the congressional split is by 2016. Some of his solutions are the same as Andrew's (e.g. federal vouchers.) Personally, I would remove the "uninsurables" from the private sector because they make it too hard to competitively price. Free market competition will get those premiums down in a hurry. Let the taxpayers see exactly how much the pre-existings cost, and combine that with the best practices panels from Commentaracare.
ReplyDeleteNot living in NY, I don't really have an appropriate baseline to compare against, but vs. what I pay currently, the silver plan premiums (which obviously that's what they want folks to focus on) are quite a bit better than what I pay now. However, the deductibles and out-of-pocket are killer! And if Andrew is correct, that they are separate rather than combined, that's even worse! (I'd like more info if you have it.)
ReplyDeleteBottom line, if I had a very bad year, under my current insurance, the most I would spend is around 7.5% of my annual income. If I had the same bad year under Obamacare in NYC, I would spend either 31% or 42% of my income (depending on whether Andrew's info is correct). So how does this help the folks that are "one illness away from bankruptcy"?
Andrew, you'll forgive the incredulity. I know Washington stupidity knows no bounds, but there are limits to what my mind can process.
BTW, Tryanmax, I tried to answer your question yesterday about the Zero Hedge blog ("Tyler Durden") this morning. I wasn't feeling very well yesterday.
ReplyDeleteI will be going on Medicare Plan "A" in a few weeks, and am currently shopping for a Medicare Supplemental (Part B.) I'm pretty sure my current providers will accept Medicare .... at least this year. As a virtual "uninsurable" I was paying 24K a year with a $40 co-pay.
ReplyDeleteTryanmax - let me know what kind of information you are looking for and I will try and get it for you. As a baseline, a single person earning $45K in Manhattan would be equivalent to earning $20-25K any place else. Rents average $2500-3000 for studio or one bedroom, and taxes eat up about 33% of income. Add in the cost of food, clothing, and entertainment and adding premiums/deductibles into the mix, it is just not affordable. And $45K is too much for any kind of aid. For those 30 and under, there is the catastrophic insurance, but the catch (if I am reading it correctly) is that everyone in the household must take the catastrophic plan. I am not sure how that plays out with roommates and such.
ReplyDeleteBTW, the readily available info does not take into consideration premiums for people with any pre-existing conditions.
ReplyDelete10J - I would think that most providers wouldn't dump current or longtime patients because of Medicare, but then what do I know. You are actually paying $24K out of pocket or for premiums? Yipes!
ReplyDeleteIn the name of CommentaramaPolitics, we command you to feel better. [Btw, that comes directly from "The Management"...]
Bev: It is true I am a medical mess, plus a long complicated story about switching from my plan to my wife's aftr I early retired. As Leslie Gore might have sung "you would cry too if it happened to you!"
ReplyDeleteJed, I agree. Until we offer a better alternative no one will listen. Moreover, until Obamacare starts to punish people with fines, this issue won't resonate outside talk radio. For most people, this is just more arguing about procedures. And since we aren't offering anything better, people will go with the guy with the plan.
ReplyDeleteAnd "compete across state lines" is not a plan... it's a Big Business slogan.
tryanmax, Sadly, I can't give it to you. I have heard people say this on financial shows, but I've never seen anyone outline it and good luck finding this out from an Obamacare site.
ReplyDeleteWhere I first saw this the other day was with a woman from an insurance institute who was arguing that young people are making the wrong calculation just by looking at cost. She wanted them to buy more expensive plans because (according to her) they will be liable for both the premium AND THEN the out of pocket costs if they get seriously sick, and she pointed out how this could be more than people are liable for now under their pre-Obamacare plans.
I have no idea why no one else is talking about this. But keep in mind that on insurance, usually the co-pay (which is what this "out of pocket" thing is) usually is separate from the deductible. I think they have intentionally blurred the idea of a cap with the co-pay with the nebulous term "out of pocket" to try to make the deductible seem smaller.
Bev, Does NY say anything about whether or not the deductible is counted toward the "out of pocket" cost or not?
ReplyDeleteNo, but they present it as separate line in the schedule of benefits. The other issue that is not in really spelled out in my report are the percentages that insurance will cover. Like most insurance plans today, they cover "wellness visits" and "preventive care" in full, It's when you get sick or need more than just the doctor looking in your ears and checking your blood pressure where the costs mount up with Obamacare. [I have always thought this to be wrong-headed. Since insurance is for the unexpected, it should cover when you need care above and beyond routine.]
ReplyDeleteThe Silver plan has a $30-$150 copay for just about everything including lab work/procedures in that "wellness visit" with the doctor.
BTW, I found the page that links to the spreadsheet that links to the actual insurance provider network. Some have info out front, some you have to fill out a "form" to get plan info. Presumably so they can call you and hound you about signing up...
Healthcare Providers.
BTW, 10J, when I wrote "I would think that most providers wouldn't dump current or longtime patients because of Medicare" I meant medical providers (doctors etc) not the insurance providers. The Insurance providers will drop you in a NY minute if you actually need to USE the insurance...
ReplyDeleteBev, by a baseline, I just mean that I know geography plays a factor in insurance rates, too. I don't know for sure, but I'd put dollars to donuts that rates are just cheaper in Nebraska, but I could be wrong. I haven't been able to mine into what rates here would be. NE opted out of the exchanges (naturally) so I have to rely on the national site. *snicker, cough-cough*
ReplyDeleteTryanmax - Of course it's geographical. Upstate counties in New York will have considerably less in premiums and choices of providers too. Cost of living and access plays a huge part of the overall cost of healthcare. And sicker people tend to congregate where they can get medical care.
ReplyDeleteLet's just say that I live within walking distance of about 10-12 major nationally ranked hospitals/medical care facilities, so my rates would be considerable higher because these facilities have the most expensive doctors/treatments - Like Memorial Sloan-Kettering, major cancer treatment facility, that, btw, does not take insurance...
Bev - as you know, $575 billion (over half) of Obama Care's $940 billion price tag was scheduled to come from future payment cuts to Medicare providers. Even his own agencies admitted as many as 20% of physicians could be driven out of business by the cuts, particularly in small rural offices where there really is no fat to begin with. I won't pretend insurance companies are friendly, but the big corporate hospitals are mostly driving the costs. And yes, it is extremely hard for a company to try and figure out a rate that keeps them solvent. These companies need the young healthies, but they have no way of knowing if they can attract an acceptable level of indestructibles to offset the uncoverables. This is why I would rather see the insurance industry go for profit of insurables. The pre-existing condition types can be placed in an assigned risk funded by the carriers, and subject to industry experts to get rid of over-use, redundancy, etc. Heck, you can bet the insurance industry would work hard at instituting loss control measures to accounts they service. Oh, BTW, the $24K is not just me--includes my wife of which I am the larger portion.
ReplyDeleteBev, The copay should be a percentage. As I understand it, the silver plans cover 70% and you pay the other 30% up to the "out-of-pocket" cost. But what I can't get an official word on is whether or not the deductible comes first or if it counts toward the out-of-pocket costs. I'm hearing that it doesn't, but I can't find anything official.
ReplyDeleteAndrew, what I can find info on is that, thanks to delays and exemptions, for 2014 many people may be faced with multiple out-of-pockets to different providers. Now, I realize some plans are already set up like this, but one of the Obamacare provisions was meant to eliminate that so that everyone would have only one out-of-pocket. Except that, for year one at least, they've actually made it worse for some people. And who knows what exemptions and delays may come in the future?
ReplyDeleteI'll be honest, health insurance has always twisted my brain. I'm surprised I grasp what I just wrote. But more fundamental than that, what I'm seeing is that wherever Obamacare causes premiums to go down, it more than socks those plans with much, much higher deductibles than typically are seen. For the people who's premiums go up, I expect their deductibles rise, as well. This flies directly in the face of helping those "one illness or accident away from bankruptcy."
I might also add that bankruptcy isn't as bad as it's made out to be. I don't recommend it, but one can walk away from it. And from what I'm told, medical bankruptcy is easier to come back from.
Here is the deal on the terms guys. co-pay is what percentage you pay for a given service; e.g. 80/20% for diognostics for example. Out of pocket normally refers to a cap; e.g the maximum amount you pay in a given year. After you hit that, the policy picks up 100%. Deductibles are per procedure. It can be $500, $1,000, etc. With two kidney stone surgries and open heart surgery, I've blown through my maximum out of pocket expense. Hope this helps, but here is a link that might help also: http://www.moneyunder30.com/health-insurance-deductible-co-pay-out-of-pocket-maximum
ReplyDeleteBut Jed, how do they relate? How does the deductible relate to the yearly out-of-pocket?
ReplyDeleteJed, This article implies twice (but doesn't actually say) that the deductible counts toward the out-of-pocket figure. But what I've seen says that is not true under Obamacare... but I can't find anyone who actually say yes/no on this.
ReplyDeletetryanmax, the 2 out-of-pocket thing is a "glitch" that vanishes next year.
ReplyDeleteThis is frustrating.
ReplyDeleteI have seen it both ways now. Most articles (99%) skip the issue even as they pretend to explain it. A handful that talk about how insurances works in a general sense assume that the deductible counts. But then I see an article like this one (LINK) which says:
"Depending on your plan, your deductible, co-payments and/or coinsurance may apply toward the out-of-pocket maximum."
I can find no one who has said which way Obamacare goes. So I am wondering if this will vary from plan to plan and will be in the small print?
This is a huge difference. It's the difference between paying another $5,000 a year if it doesn't count.
Andrew, historically they do. I found an article in Forbes that states for silver plans, it may vary from plan to plan whether deductibles are counted in the out-of-pocket max. Here is the link. So, it may two different options with different premiums: http://www.investopedia.com/articles/personal-finance/092413/how-choose-between-bronze-silver-gold-and-platinum-health-insurance-plans.asp?partner=fdc
ReplyDeleteProbably another great example why this is such a clusterfudge
ReplyDeleteJed, This reeks of intentionally hidden to me. Basically, this makes the out-of-pocket cost promise a lie and the effect is to present deceptively low premiums because the premiums are kept down by essentially letting them lie about the deductible and charge almost double what they appear to be charging. That's basically a $400 a month hidden premium if you're sick on top of the $300 a month premium disclosed.
ReplyDeleteAndrew - I can't find any info about whether the deductible and "out of pocket" expenses are part of the same pot of money one must spend. The lower the premiums, the higher the deductible and out of pocket expenses. That's obvious.
ReplyDeleteBev, It looks like it will be one of those of those pleasant little surprises people will discover when it's too late... unless they know to ask.
ReplyDeleteNo matter what, from the figures I've been able to find, the deductibles and co-pays are always much higher than anything I've seen before. Granted, it's been about five years since I had to buy my own insurance, but much of what I've seen in Obamacare is double what I'd expect or more. So whether they are combined or separate, the fact still remains that they are hiding true costs from the premium and, not to be a broken record, totally trashing the promise to save those who are one illness from bankruptcy. I guess what I'm getting at is, that should be the Republicans' #1 talking point about Obamacare, but clearly we Commentaramaniacs have done more digging than they have.
ReplyDeletetryanmax, I agree. This is a total violation of several promises:
ReplyDelete1. Keep your insurance.
2. Affordable.
3. Easy
4. You can compare.
5. One illness away from bankruptcy.
On your second point, that is the problem of the modern era. The radio talkers are in their anti-Republican tantrum, so they can only be bothered to scream "socialism!!" at this; all the rest requires too much thought. The Republicans aren't thinkers. Places that would have looked at this like Heritage Foundation in the past have gone fringe and are worried about gay Mexicans now. Regular journalists have gotten lazy and just repeat what they are told without doing actual investigation. Political journalists are ideologically in favor. The Democrats are liars.
Who does that leave? Us. That's really sad.
An out-of-pocket expense maximum, or cap, is the amount that you have to meet in order for the insurance company to pay 100 percent of your policy's benefits. As we mentioned before, the out-of-pocket expenses that can be applied toward this maximum amount include your deductible and coinsurance. Co-payments and your monthly insurance premium do not apply to the out-of-pocket expense maximum.
ReplyDeleteWhat exactly is the purpose of this cap? It benefits both you and the insurance company. The benefits to the insurance company are obvious. If health care expenses are shared with the policyholder, it cuts down costs. However, it can also help you by ensuring that your medical bills are covered in the event of a catastrophic medical situation. For example, caps are normally set at around $2,000 to $3,000 per year but can vary widely. Many healthy people rarely meet the cap. But if you have a sudden illness or chronic condition, you could easily meet the cap in the first month or two alone. After that, the insurance company will cover you 100 percent to the policy maximum for the remainder of the year, ensuring proper health care during a critical time. Once you meet your out-of-pocket expense maximum, your insurance company will then cover 100 percent of the "reasonable" or "customary" fee of a provider. These fees are determined by your insurance company. If, however, a provider's fee does not fall into the "reasonable" or "customary" category, you could be responsible for paying at least a portion (if not all) of the fee.
I looked at section 1302 (c) of the Affordability Act. Basically, deductibles are in general considered "out of Pocket" expense. The exception is if you are in a plan with a network, and there are cat services provided by an Out of network provider so you end up with multiple billing of services.
ReplyDeleteJed, We get that. The problem is that apparently sometimes the deductible counts toward the out-of-pocket costs and sometimes it doesn't under Obamacare.
ReplyDeleteSo really, while you will $6,500 as the out-of-pocket max each year, if you buy the wrong insurance it could really be $11,500 if the deductible doesn't count toward that. And this is something that is being very carefully hidden by the Obamacare websites and by the people writing about how great these policies are.
An out-of-pocket expense maximum, or cap, is the amount that you have to meet in order for the insurance company to pay 100 percent of your policy's benefits. As we mentioned before, the out-of-pocket expenses that can be applied toward this maximum amount include your deductible and coinsurance. Co-payments and your monthly insurance premium do not apply to the out-of-pocket expense maximum.
ReplyDeleteWhat exactly is the purpose of this cap? It benefits both you and the insurance company. The benefits to the insurance company are obvious. If health care expenses are shared with the policyholder, it cuts down costs. However, it can also help you by ensuring that your medical bills are covered in the event of a catastrophic medical situation. For example, caps are normally set at around $2,000 to $3,000 per year but can vary widely. Many healthy people rarely meet the cap. But if you have a sudden illness or chronic condition, you could easily meet the cap in the first month or two alone. After that, the insurance company will cover you 100 percent to the policy maximum for the remainder of the year, ensuring proper health care during a critical time. Once you meet your out-of-pocket expense maximum, your insurance company will then cover 100 percent of the "reasonable" or "customary" fee of a provider. These fees are determined by your insurance company. If, however, a provider's fee does not fall into the "reasonable" or "customary" category, you could be responsible for paying at least a portion (if not all) of the fee.
Here is the best explanation link I've found: http://www.kaiserhealthnews.org/Features/Insuring-Your-Health/2013/061113-Michelle-Andrews-out-of-pocket-costs.aspx
ReplyDeleteAndrew, it's something I just realized today. Very rarely do you hear anyone criticize Obama over the broken promises, and if they do, they never bother to explain. They just spit "Obama is a liar" as if we should all come to the program with our assigned reading completed. That leaves the defenders to 1) cite the promises that aren't broken, 2) ignore the broken promises, and/or 3) offer false rebuttals that automatically win in the absence of a counter-argument.
ReplyDeleteThe other thing is that "the premiums are hidden in the out-of-pockets" is so dreadfully simple, most people could grasp that. Instead, the right wants to focus wonkishly on the baffling complexity of it all. But that doesn't work b/c people don't expect to have to face that complexity. They assume they'll be able to call someone or log-on and some bureaucrat will do it for them. And they may be right. But they're just not thinking of the downside of that and any attempt to make them becomes an attack on government workers, a non-starter for a lot in the middle.
...caps are normally set at around $2,000 to $3,000 per year...
ReplyDeleteThat's what I thought. But what I'm finding on Obamacare plans are caps anywhere from $4000 to $12,000. I'm not seeing any that are in the "normal" range. That said, I have been mostly looking at silver and bronze plans. They could be that low on the gold plans, but then you have the higher premium.
tryanmax, Simple is always best. If you want to attack something, find very easy ways for people to "get" what you are talking about. The problem with modern conservative thinking is that it's deeply ideological and it wrongly assumes that people have been keeping up with the arguments. That's not how you win over the public. The public only pays attention to things that grab them, things they can understand quickly and easily, and things they can relate to themselves. "It's all socialism" is meaningless because no one knows what that means or what it means to them-- and it's ridiculously simple to shoot down... "having businesses compete is socialism?" By comparison, "You will pay twice what he claims... you're going to lose your insurance... you can get hit with a $40k medical bill" will resonate because people know what this means.
ReplyDeleteAs for the lies, again, it's an ideological problem. They think that screaming "socialist" or "liar" is enough. It's not. You need something specific when you make a political charge. You keep people on the defensive by controlling the terms of the debate and you can't control the terms of the debate if you just lob a generic charge at the other guy... those are really easy to refute because you can say anything you want.
Look above. "It's socialism" is wide open and he can laugh that off in any number of ways. "This will cost you twice as much" is very narrow and forces you provide a specific response. The difference is who control and establishes the terms of the debate.
With rent and everything else being what it is, can anyone live in Manhattan making $45,000 a year, period? I would have guessed no (unless you're on welfare, of course).
ReplyDeleteOn the whole "socialism" thing, I would tend to agree, especially since your opponents come back at you with equally stupid things like "Yeah, @#$% socialism, we don't need roads." (sigh)
OBAMA IS A SOCIALIST MARXIST AND HE MUST BE STOPPED!!!!!!!
ReplyDeleteSAME WITH THOSE RINO PUSSIES MCCONNELL AND BOEHNER!!!!
HIHIP@$%HI#HQ^HFIOH#IO^H&^I(FERNTV$N$O%H(%B^%$()*FD54526745$#FC#W$#$%%^F^$@66#CGTRD^!!!!!!!!!!!
T-Rav - yes, you can live in Manhattan for $45K with many compromises like living in with many roommates or as I did with the 1990 equivalent salary which was luck and a roommate who was willing to sleep in the living room of a small one bedroom 5th floor walk up illegal sublet and eating a lot of peanut butter...
ReplyDeleteThough I doubt one could find that kind of ideal situation in Manhattan these days.
Kit - you okay or do we need to cal in the kittens?
ReplyDeleteYeah, I don't get huge city living. Chicago was the absolute largest I could handle.
ReplyDeleteYeah, I'm fine. :)
ReplyDelete