Dumped by Aetna

[AdrianC]

We got the official letter today. We've had private health insurance with Aetna for nine years, with only routine claims. This is an off-exchange health plan, not Obamacare.

I assume we will be able to get coverage through another company, probably Blue Cross. I expect we will be changing doctors, again.

This is crazy.

[Paul der Krake]

How is this crazy?

[Mr. Green]

How is this crazy?

I would assume the OP thinks it's crazy because an insurance company is dropping coverage for a person who has only a minor claims history. Off market plans would presumably be priced more profitably for an insurer so what's the reasoning behind dropping a customer who has used little insurance? It's entirely possible this is part of Aetna's power play to push their merger through regulatory scrutiny.

[marty998]

How is this even legal to do?

A portion of your annual premiums are set aside and invested by the insurance company to pay for future claims in decades ahead. Essentially they are saying "thank you, we'll take those profits that you've been giving us when you're relatively healthy, and you don't get any benefit when you are likely to need it when you are older".

[Mr. Green]

How is this even legal to do?

A portion of your annual premiums are set aside and invested by the insurance company to pay for future claims in decades ahead. Essentially they are saying "thank you, we'll take those profits that you've been giving us when you're relatively healthy, and you don't get any benefit when you are likely to need it when you are older".

I believe an insurer in the US can drop you for any reason. If the insurer is making money off of someone then it doesn't make a whole lot of business sense to drop them. What's strange is that if an insurer was dealing with profitability issues, they would typically raise rates, not just drop a customer outright. I wonder if Aetna is exiting the OP's market altogether.

Aetna and Humana are trying to complete a merger and many folks think regulatory bodies won't allow it because the combined company would reduce competition in the insurance industry too much. In response, Aetna has abandoned their participation in the ACA exchanges and has even said publicly that it was because of the likelihood that the government won't let the merger go through. I suppose their idea was to say their current position was not sustainable and that the merger would save money that would allow them to continue participating. A classic power play. I can't help but see a customer, who looks profitable to an insurer, dropped as a means to further Aetna's attempt to complete the merger. That's just speculation on my part though.

[AdrianC]

How is this crazy?

It's crazy that we don't know if we will be able to obtain affordable health insurance.

It's crazy that we have to change our doctors every year.

It's a crazy system.

Single payer is the right solution. We all know it. Politically it cannot be done. So we have this mess.

[Paul der Krake]

It's crazy that we don't know if we will be able to obtain affordable health insurance.

What? There's a website. You can get an answer with a price estimate in about 15 minutes. You may not like the numbers, but they will be there.

It's crazy that we have to change our doctors every year.

You said you have been with Aetna with 9 years. How often have they made you switch? Personally I don't give a toss about who sees me, but I realize this matters to people with chronic conditions who see their GP more than once every 3 years when I need a shot for travel.

It's a crazy system.

Agreed. Burn it to the ground.

Single payer is the right solution. We all know it. Politically it cannot be done. So we have this mess.

Single payer, or a Germany-style hybrid system, or anything else that isn't what we currently have.

How is this even legal to do?

A portion of your annual premiums are set aside and invested by the insurance company to pay for future claims in decades ahead. Essentially they are saying "thank you, we'll take those profits that you've been giving us when you're relatively healthy, and you don't get any benefit when you are likely to need it when you are older".

I despise insurance companies as much as the next guy, but that's a terrible argument and not how insurance works. There is no agreement on either side to maintain a relationship beyond the term that is agreed upon. In fact consumers hold on over the company in that they can cancel whenever they want but the company must typically wait until the end of what's usually a 12 month term.

[Rocket]

Not crazy at all.  I work for a very large company which had great health insurance 20 years ago.  Every year its gotten worse.  The plans offered change every year so your doctors are likely to change.  The PPO option that allowed you to see anyone went away.  The charge to employees went up each year.  This was happening before Obamacare.  Nine years with the same plan and doctors is a long time in today's environment.  From the news, Aetna says is dropping your area because its not profitable. 

[AdrianC]

It's crazy that we don't know if we will be able to obtain affordable health insurance.

What? There's a website. You can get an answer with a price estimate in about 15 minutes. You may not like the numbers, but they will be there.

What if all the insurance companies decide my city is unprofitable and they all pull out? I'm not sure if there is provision within the ACA to fix this.

[Paul der Krake]

It's crazy that we don't know if we will be able to obtain affordable health insurance.

What? There's a website. You can get an answer with a price estimate in about 15 minutes. You may not like the numbers, but they will be there.

What if all the insurance companies decide my city is unprofitable and they all pull out? I'm not sure if there is provision within the ACA to fix this.

That's an interesting (or terrifying if it applies to you) question. Apparently there are a few counties that are at risk of not having a single option next year. We can only hope that a new exemption will be added so that people aren't stuck paying the penalty through no fault of their own.

[Tom Bri]

Until this spring I worked for a smaller health insurance company. In 2013 we dropped all of our Major Medical plans. Not a huge number in the grand scheme of things, some 10,000 people nationally. But they were pretty unhappy. Some had been with us for more than a decade.

The ACA changed things. I don't know what triggered our management to make that call, except that obviously, the trouble wasn't worth whatever small profit we made on those plans. None of us were surprised. The ACA was a disaster for the smaller players. In my opinion, that was a big part of its original intent. The big players saw an opportunity to cut out and eliminate competition, which is why they were so eager to back it. I gotta kinda hope they all go belly up. Kaiser, BCBS, Aetna, UHC. They can all go eat sh1t.

[Exflyboy]

And if Trump gets in he promises to go back to the pre ACA hell we had before..

God help us!

[Mr. Green]

What an incredible advantage to being FIRE if that were to happen. We can use geographical arbitrage to go live somewhere else for a little while, rather than suffer excessive damage to our stashes just because the US can't get its act together on healthcare.

[jim555]

If the US goes pre-ACA then I will be using geographical arbitrage to move to a country that won't bankrupt me for health insurance.

[AdrianC]

And if Trump gets in he promises to go back to the pre ACA hell we had before..

No, no, no. He said he would replace Obamacare with "something wonderful".

It'll be great, believe me.

[BTDretire]

And if Trump gets in he promises to go back to the pre ACA hell we had before..

God help us!

Pre ACA I was geting about 8% yearly increases in my BCBS.
In 2012 when ACA regulations started, I was paying $4,700, I got increases of 18.4%, 19.2% and 23%, the next three years.
 I think the ACA screwed the price of my private policy.
I'm now paying $8,700 for a family of four, a Bronze ACA policy is almost $16,000.
  Almost doubled the cost of insurance to sign up 4% of our 320 million citizens.

Yes, God help us, when the government tries to.

[tipster350]

And if Trump gets in he promises to go back to the pre ACA hell we had before..

God help us!

Pre ACA I was geting about 8% yearly increases in my BCBS.
In 2012 when ACA regulations started, I was paying $4,700, I got increases of 18.4%, 19.2% and 23%, the next three years.
 I think the ACA screwed the price of my private policy.
I'm now paying $8,700 for a family of four, a Bronze ACA policy is almost $16,000.
  Almost doubled the cost of insurance to sign up 4% of our 320 million citizens.

Yes, God help us, when the government tries to.

Without knowing the particulars of your situation, the percentage increases your were seeing probably had something to do with your age. The ACA smoothed out the pricing for plans so that the younger people pay more than they would have in the past, and the older people pay less than they would have in the past. There are rules about the spread in pricing now. So on the one hand this smoothing hurts now if you are younger, but on the other hand will work out as you get older.

[Dollar Slice]

Aetna is the worst insurance co. I've ever worked with, so maybe you will end up somewhere better, at least?

My company's premiums got raised by Aetna 37% as of this week. And I just read that they're buying Apple Watches for all 50,000 of their employees. I'm sure these two things are not related. But it sure FEELS related. :-/

[AdrianC]

Aetna is the worst insurance co. I've ever worked with, so maybe you will end up somewhere better, at least?

Can't be much worse. Their claims handling is awful. They remind me of the insurance company in the John Grisham book The Rainmaker - their policy was to deny all claims initially. Aetna isn't much better. We've routinely been denied coverage of the kids annual well-checks. They always pay it after an argument. How can that be efficient?

[Dollar Slice]

Aetna is the worst insurance co. I've ever worked with, so maybe you will end up somewhere better, at least?

Can't be much worse. Their claims handling is awful. They remind me of the insurance company in the John Grisham book The Rainmaker - their policy was to deny all claims initially. Aetna isn't much better. We've routinely been denied coverage of the kids annual well-checks. They always pay it after an argument. How can that be efficient?

Exactly the same experience. Denied for routine blood tests performed by my PCP, denied for a trip to one of those drug store minute clinics when I had an emergency on a Sunday night because they said I needed a referral from my PCP (that one took eight months to clear up)... Denied for a specialist visit because the doctor whose name I got from Aetna's own website isn't in their network... ?!?

I emailed and told them that it's gotten so bad that I get a feeling of sinking dread in the pit of my stomach every time I get an email notification from them, because I'm scared they've denied another claim and the bureaucratic nightmare will begin again...

[JAYSLOL]

Switch doctors because of the insurance company?  That sucks.  And Americans laugh at our healthcare here in Canada, lol. 

[Cpa Cat]

Did they drop you or did they drop your plan? Is it even possible for an individual to get dropped by insurance anymore? They can't actually deny you coverage. So I'm guessing it's your plan that got erased - not you.

I received a letter from Coventry saying they discontinued my plan, but really they just removed it from the ACA exchange and replaced it with an identical off-exchange plan. My husband's BCBS plan is being eliminated due to high costs. I'm hoping it's the same thing - just going to be switched to an off-exchange plan.

If you like your plan and like Aetna, they may have something very similar to your old plan available - unless they've completely stopped offering insurance in your state.

I'm going to use a health insurance broker this year. I don't feel that the Marketplace really works for people who don't qualify for ACA subsidies.

[Tom Bri]

Switch doctors because of the insurance company?  That sucks.  And Americans laugh at our healthcare here in Canada, lol.

:-) It's the government here, more than the health system itself. We are two very different populations tied together by one government, which doesn't serve either side very well. A full-bore Euro-style system probably wouldn't work too badly, if it were limited only to those states that voted for it. I think Mit Romney had the right idea. Bring in a system approved by the voters of that one state and see if it works. The error was trying to foist a bastardized federal system on all the rest of us.

Likewise, an old-fashioned, pre-WWII-style open market would probably work just fine in those states that wanted it. We'll never know.

[dogboyslim]

How is this even legal to do?

A portion of your annual premiums are set aside and invested by the insurance company to pay for future claims that occur during the policy period. in decades ahead. Essentially they are saying "thank you, we'll take those profits that you've been giving us when you're relatively healthy, and you don't get any benefit when you are likely to need it when you are older".

IFYP.  A company cannot reserve for a claim unless it has happened.  The premiums come in the door as an unearned premium reserve that is a liability.  As the policy term expires, the UEPR gets moved to revenue (earned premium).  Most health policies are one year policies.  The concept you mention is a long-term contract accounting, not a 1-year contract accounting.  This is why the mix of business is such a big deal to a health insurance company.  They need to have young and healthy people to overcharge so they can undercharge the older or unhealthy people.  This subsidization is done by design at the behest of our congress critters.  To some degree they can adjust premiums for these things, but the system of pricing we have in place today won't work if all the young healthy people drop out, hence the new requirement that everyone has to be insured or pay a fine.

[Blonde Lawyer]

Quick question for those of you that have had to change doctors because your insurance changed.  Do you have a bunch of independent doctors available? Where I live, there are no small private practices anymore.  All doctors are employed by Hospital A, Hospital B or Hospital C, even if they operate out of a small building far away from the actual hospital.  Every insurance plan offered around me has the 3 hospitals as in-network.  I guess I'm lucky.  I hate that I have few options for competition.  I have to stay in the good graces of the three hospital systems.  But, the plus side is, everything is in network then.

[AdrianC]

Did they drop you or did they drop your plan? Is it even possible for an individual to get dropped by insurance anymore? They can't actually deny you coverage. So I'm guessing it's your plan that got erased - not you.

You're correct. Aetna are dropping the plan. They've done that to us several times before, but always offered an alternative plan we could choose (that's why we've had to change doctors). This time they are offering no alternative plans "at this time".

If you like your plan and like Aetna, they may have something very similar to your old plan available - unless they've completely stopped offering insurance in your state.

As far as we know right now it's the latter. Aetna are pulling out of individual plans in our area.

[BTDretire]

And if Trump gets in he promises to go back to the pre ACA hell we had before..

God help us!

Pre ACA I was geting about 8% yearly increases in my BCBS.
In 2012 when ACA regulations started, I was paying $4,700, I got increases of 18.4%, 19.2% and 23%, the next three years.
 I think the ACA screwed the price of my private policy.
I'm now paying $8,700 for a family of four, a Bronze ACA policy is almost $16,000.
  Almost doubled the cost of insurance to sign up 4% of our 320 million citizens.

Yes, God help us, when the government tries to.

Without knowing the particulars of your situation, the percentage increases your were seeing probably had something to do with your age. The ACA smoothed out the pricing for plans so that the younger people pay more than they would have in the past, and the older people pay less than they would have in the past. There are rules about the spread in pricing now. So on the one hand this smoothing hurts now if you are younger, but on the other hand will work out as you get older.

Your response reads like you think I have an ACA plan, I don't. This was a private BCBS policy, the price was driven up by new regulations in the ACA for excisting private policies. Such as unlimited benefits, I had $5,000,000. there were a few others that I don't recall now. Yes, each year I got a year older, so that was part of it.
As I said I'm paying $8,700 now, an ACA policy about $16,000. Minus any tax payer
paid subsidy.

[AdrianC]

As I said I'm paying $8,700 now, an ACA policy about $16,000. Minus any tax payer
paid subsidy.

Interesting. We shopped the ACA exchange last year and a bronze plan was the same cost as the plan offered direct from Aetna with the same coverage ($13,023/year). We didn't qualify for any subsidies so bought direct as usual.

We might qualify for subsidies next year so I'm going to look at plans on the exchange...assuming there are some.

[BTDretire]

As I said I'm paying $8,700 now, an ACA policy about $16,000. Minus any tax payer
paid subsidy.

Interesting. We shopped the ACA exchange last year and a bronze plan was the same cost as the plan offered direct from Aetna with the same coverage ($13,023/year). We didn't qualify for any subsidies so bought direct as usual.

We might qualify for subsidies next year so I'm going to look at plans on the exchange...assuming there are some.

 I have a $10k deductible, that may be the difference.
Back when I first raised my deductible from $2,500 to $10,000,
the premium changed from $9,900 to $4,512. A HUGE difference!
 I gave myself a nice facepunch for not increasing the deductible earlier.
But, I didn't know about the big premium difference.

[Mr. Green]

I just got a notice from CareFirst that my plan is not being continued next year. Oddly enough the replacement plan is called the exact same thing (maybe that's SOP for exchange plans?). My premium is jumping from $161.54 to $261.32, an increase of 61.8%. Yikes! The commission that oversees health insurance rates says CareFirst was granted increases of ~30% for 2017 so I'm not sure where the other ~30% is coming from. I find it hard to believe there would be a 30% increase just from being 33, as opposed to 32 this year. We don't currently get any subsidies because our income this year is too high. This will certainly be a consideration for next year if my wife is thinking about quitting.

[AdrianC]

I have a $10k deductible, that may be the difference.
Back when I first raised my deductible from $2,500 to $10,000,
the premium changed from $9,900 to $4,512. A HUGE difference!
 I gave myself a nice facepunch for not increasing the deductible earlier.
But, I didn't know about the big premium difference.

Our deductible is: Individual $6,850 / Family $13,700 (in network).

This was the maximum deductible we saw when shopping for a new plan last year.

We are all healthy and take care of ourselves so we're happy to go with high deductibles.

[AdrianC]

Well, this might have a happy outcome. Being dumped by Aetna made me do serious research on our options. Turns out we might *just* have qualified for a subsidy in 2016 if we had bought on the Healthcare.gov exchange. A cap gain on a mutual fund tipped us over, but that was a voluntary sale. Glad to get out of that hyper-actively managed fund, though.

I started a self-employed 401k for 2016, which lets me deduct more from a smaller income than the SEP I was using. That brings our MAGI down almost to 400% of FPL. Next year our MAGI will be less than 400% of FPL for sure (we will make it so). We are looking forward to shopping for a Silver plan on the exchange (again, assuming there are some...).

[Spork]

Don't forget: you can also lower your AGI with an HSA (if you buy compatible insurance).  If you're at the edge, $6750 might pull you right in.  ($6750 assuming you are married.)

[JG in Hangzhou]

If the US goes pre-ACA then I will be using geographical arbitrage to move to a country that won't bankrupt me for health insurance.

I already did!
My wife, 10 year old daughter and I live in Hangzhou China and we paid all medical and dental expenses out of pocket, for the last 8 years.   Even if we had insurance, it would cost more to submit the bills than it did to get the help.  It's about a $1 (USD) to see a doctor, $20 for a full medical checkup including ultrasound (they actually located a stone in my kidney) and x-rays, and about $30 to get a tooth filling replaced.  Though what really blew my mind was that when we went to Taiwan, my wife bought her thyroid medicine over the counter and got a three month supply for less than $5.