Author Topic: ACA without the exchange?  (Read 2828 times)

BlueMR2

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ACA without the exchange?
« on: July 31, 2017, 03:39:22 PM »
I'm noting that an awful lot of places, including near me have lost all their providers from the exchange.  Is there any way to leverage ACA when there are no exchange plans available?  Can you take it off your taxes or something and apply it to normal private health insurance?

Spork

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Re: ACA without the exchange?
« Reply #1 on: July 31, 2017, 03:45:19 PM »
following.  It's not a problem here.... yet.  But it seems like a potential issue anywhere.

sol

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Re: ACA without the exchange?
« Reply #2 on: July 31, 2017, 03:54:53 PM »
There are now something like 40 counties where insurers have have decided to offer zero ACA compliant plans.  In these places you can still buy health insurance, but you basically buy it the way we did before the ACA was passed, without any subsidies and without any controls over what the plans have to cover.

Sorry.

Most of these counties are concentrated in like three states.  Personally, I think congress should offer a single public option plan in places like this, where the private healthcare market has basically withdrawn and left people to fend for themselves.

iris lily

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Re: ACA without the exchange?
« Reply #3 on: August 01, 2017, 07:48:34 AM »
...but you basically buy it the way we did before the ACA was passed, without any subsidies and without any controls over what the plans have to cover...


...which might be a good thing for the OP.

One size does not fit all

ncornilsen

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Re: ACA without the exchange?
« Reply #4 on: August 01, 2017, 09:33:52 AM »
There are now something like 40 counties where insurers have have decided to offer zero ACA compliant plans.  In these places you can still buy health insurance, but you basically buy it the way we did before the ACA was passed, without any subsidies and without any controls over what the plans have to cover.

Sorry.

Most of these counties are concentrated in like three states.  Personally, I think congress should offer a single public option plan in places like this, where the private healthcare market has basically withdrawn and left people to fend for themselves.

-Private healthcare has not withdrawn from these areas - they are simply not offering ACA plans. they may offer other plans.
 
-Perhaps this should signal that perhaps, the ACA has some glaring defects that need corrected. The democrats refusal to come to the table to discuss changes that could be made to fix it is killing people. So is the republicans refusal to do much more than repeal it and replace it with uh, well, it'll be great. the best. trust me, you'll love it.




sol

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Re: ACA without the exchange?
« Reply #5 on: August 24, 2017, 09:43:42 PM »
There are now something like 40 counties where insurers have have decided to offer zero ACA compliant plans.  In these places you can still buy health insurance, but you basically buy it the way we did before the ACA was passed, without any subsidies and without any controls over what the plans have to cover.

Sorry.

Most of these counties are concentrated in like three states.  Personally, I think congress should offer a single public option plan in places like this, where the private healthcare market has basically withdrawn and left people to fend for themselves.

As of today, there are now zero (not 40) counties without any ACA insurance providers.  Every single one of those marketplaces found an insurance company willing to offer ACA compliant plans.

Looks like the ACA isn't failing after all.

Spork

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Re: ACA without the exchange?
« Reply #6 on: August 25, 2017, 09:38:41 AM »
There are now something like 40 counties where insurers have have decided to offer zero ACA compliant plans.  In these places you can still buy health insurance, but you basically buy it the way we did before the ACA was passed, without any subsidies and without any controls over what the plans have to cover.

Sorry.

Most of these counties are concentrated in like three states.  Personally, I think congress should offer a single public option plan in places like this, where the private healthcare market has basically withdrawn and left people to fend for themselves.

As of today, there are now zero (not 40) counties without any ACA insurance providers.  Every single one of those marketplaces found an insurance company willing to offer ACA compliant plans.

Looks like the ACA isn't failing after all.

You'd probably need to poll the folks in each county.   The first few years of ACA, we had only Blue Cross.  The cost was fine, but there just were very few doctors on the plans.  If you had any sort of established physicians, you were sort of screwed.  You were left with docs that were new in town (just moved or just out of school) trying to establish a practice.  Not necessarily bad... but a bit of a crap shoot. 

Our county *did* fix itself.  A second insurance company moved in and provided better service to more doctors.

I'm not necessarily saying they're all broken.  I just think there is more to it than "a provider exists."  It has to have a supporting medical community.

nawhite

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Re: ACA without the exchange?
« Reply #7 on: August 25, 2017, 10:13:32 AM »
I'm noting that an awful lot of places, including near me have lost all their providers from the exchange.  Is there any way to leverage ACA when there are no exchange plans available?  Can you take it off your taxes or something and apply it to normal private health insurance?

Are you looking for ways to get the subsidy or just insurance? Private insurance is still available even in areas without any or with few plans on exchanges but you can only get the subsidy with an exchange plan.

If you aren't looking for a subsidy, then just call up insurers locally or check their websites and they'll offer you full price plans.

sol

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Re: ACA without the exchange?
« Reply #8 on: August 25, 2017, 10:52:43 AM »
I just think there is more to it than "a provider exists."  It has to have a supporting medical community.

Sure, I can agree with that.  The availability of ACA compliant insurance plans doesn't mean they are necessarily the best choice for you, and you have always the opportunity to buy outside of the ACA exchanges.  That didn't change when the ACA made their plans better.

Mostly, I think this 100% ACA availability report is news because it means the free market hasn't completely failed in these rural counties.  Those places are difficult (barely profitable) markets for profit-driven insurance companies, but it turns out they are still profitable enough.  Republicans in Congress have (strangely) argued that the free market failed to provide good comprehensive insurance to Americans in sparsely populated rural counties, and used this as evidence that the ACA was failing.  The argument never really made sense to me anyway, but at least now they've lost the ability to make the argument.

The American health care system has some definite problems.  Insurers pulling out out of the ACA exchanges isn't one of them.

BlueMR2

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Re: ACA without the exchange?
« Reply #9 on: August 26, 2017, 08:25:56 AM »
Are you looking for ways to get the subsidy or just insurance? Private insurance is still available even in areas without any or with few plans on exchanges but you can only get the subsidy with an exchange plan.

If you aren't looking for a subsidy, then just call up insurers locally or check their websites and they'll offer you full price plans.

The subsidy.  Getting a private plan is easy.  Paying for it is the problem.  Last time I had a private plan was back in 2006 and it was $62 a month for a really great plan.  Looking now as I'm considering finally going RE I'm suffering horrible sticker shock.  Now it's over $1000 a month for the most basic catastrophic only plan.  Most of that's being married though.  $62 was a single rate and I could still get decent single coverage (male) for around $400.  The killer is insurance for my wife.  Man oh man is it expensive to be female!  Her insurance rate is around double mine.  I had no idea.   At least we don't have kids...  One of my friends with multiple children is at $2300/mo for insurance now.

Thinking I'll OMY it for a bit to see how things go with healthcare...  Technically the numbers work even at the full price, but spending 50%+ of our budget on healthcare insurance (nevermind other things such as our routine vision checkups which are not covered and have jumped up 4x in the last 2 years) alone just makes me feel so sad.

Spork

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Re: ACA without the exchange?
« Reply #10 on: August 26, 2017, 08:58:54 AM »
Are you looking for ways to get the subsidy or just insurance? Private insurance is still available even in areas without any or with few plans on exchanges but you can only get the subsidy with an exchange plan.

If you aren't looking for a subsidy, then just call up insurers locally or check their websites and they'll offer you full price plans.

The subsidy.  Getting a private plan is easy.  Paying for it is the problem.  Last time I had a private plan was back in 2006 and it was $62 a month for a really great plan.  Looking now as I'm considering finally going RE I'm suffering horrible sticker shock.  Now it's over $1000 a month for the most basic catastrophic only plan.  Most of that's being married though.  $62 was a single rate and I could still get decent single coverage (male) for around $400.  The killer is insurance for my wife.  Man oh man is it expensive to be female!  Her insurance rate is around double mine.  I had no idea.   At least we don't have kids...  One of my friends with multiple children is at $2300/mo for insurance now.

Thinking I'll OMY it for a bit to see how things go with healthcare...  Technically the numbers work even at the full price, but spending 50%+ of our budget on healthcare insurance (nevermind other things such as our routine vision checkups which are not covered and have jumped up 4x in the last 2 years) alone just makes me feel so sad.

FWIW: Private plan for us in the 2006-2009 time frame was about $200/mo for married couple.  It was a high deductible plan, but EVERYONE in town took it.  It was not attached to a dedicated provider list.  And even out of pocket expenses were heavily discounted due to their negotiation.  Fast forward to 2015.  Same company, similar plan.  Pre-subsidy cost $700/mo.  Post subsidy cost: $250/mo.  But then the plan was tied to a provider network with very few docs in it.

sol

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Re: ACA without the exchange?
« Reply #11 on: August 26, 2017, 09:24:11 AM »
FWIW: Private plan for us in the 2006-2009 time frame was about $200/mo for married couple.  It was a high deductible plan, but EVERYONE in town took it.  It was not attached to a dedicated provider list.  And even out of pocket expenses were heavily discounted due to their negotiation.  Fast forward to 2015.  Same company, similar plan.  Pre-subsidy cost $700/mo.  Post subsidy cost: $250/mo.  But then the plan was tied to a provider network with very few docs in it.

I'm sure you don't need me to explain this to you, but part of that increase is the ACA's coverage increases.  Your old $200/mo plan didn't cover adult children to age 26.  Your old plan could deny you when you applied for coverage if you had previously been injured or diagnosed with something, so it was only available to healthy people.  Your old plan could immediately drop you, if you ever became injured or received a diagnosis.  Your old insurance could charge you more if you were a woman than if you were a man.  Your old plan had a lifetime cap on payouts, and it's decisions could not be appealed.  Your old plan existed in a system that left tens of millions of people uninsured if they were born poor or sick.

The ACA increases insurance costs, but it also dramatically improved American health insurance.  I don't want to go back to those days.

BlueMR2

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Re: ACA without the exchange?
« Reply #12 on: August 27, 2017, 06:03:13 AM »
The ACA increases insurance costs, but it also dramatically improved American health insurance.  I don't want to go back to those days.

Yeah, I kind of like to think of it as a charity.  It's going to really help out a lot of the people that need it most.  It does come at my expense though.  We're skipping checkups now because they cost so much more than they used to.  So, our risk goes up some, but we're pretty healthy to begin with and I know it'll help a ton of people that were not getting any care at all before!

Spork

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Re: ACA without the exchange?
« Reply #13 on: August 27, 2017, 08:17:34 AM »
FWIW: Private plan for us in the 2006-2009 time frame was about $200/mo for married couple.  It was a high deductible plan, but EVERYONE in town took it.  It was not attached to a dedicated provider list.  And even out of pocket expenses were heavily discounted due to their negotiation.  Fast forward to 2015.  Same company, similar plan.  Pre-subsidy cost $700/mo.  Post subsidy cost: $250/mo.  But then the plan was tied to a provider network with very few docs in it.

I'm sure you don't need me to explain this to you, but part of that increase is the ACA's coverage increases.  Your old $200/mo plan didn't cover adult children to age 26.  Your old plan could deny you when you applied for coverage if you had previously been injured or diagnosed with something, so it was only available to healthy people.  Your old plan could immediately drop you, if you ever became injured or received a diagnosis.  Your old insurance could charge you more if you were a woman than if you were a man.  Your old plan had a lifetime cap on payouts, and it's decisions could not be appealed.  Your old plan existed in a system that left tens of millions of people uninsured if they were born poor or sick.

The ACA increases insurance costs, but it also dramatically improved American health insurance.  I don't want to go back to those days.

First off: I do understand.  But there is a lot of coverage I didn't want.  I don't have kids.  I find it extremely silly to have full coverage for routine expenses.  I don't need to pay more to cover routine things that I was already paying for.  That just adds overhead to what was already being spent.

And, as mentioned before, in many areas the new plans often provide *coverage* ... while all the medical community drops out of them.  Insurance with few or poor medical providers is not overly useful.

sol

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Re: ACA without the exchange?
« Reply #14 on: August 27, 2017, 09:02:59 AM »
We're skipping checkups now because they cost so much more than they used to.

The ACA plans are supposed to have zero-cost preventative care visits.  Checkups shouldn't cost you anything.  What sort of plan are you on?