Obamacare in NJ: many existing plans cancelled, replaced by higher rates & deductables

[brentspeak]

This article seems to correspond with the national trend re. Obamacare: for those who have very high-costing existing policies which are crappy, an opportunity to get a "slightly more affordable" equally crappy policy might now be available (i.e., the first person discussed in the article). But for those are currently satisfied with their existing individual plans (see below) -- those people will get hosed.

http://www.nj.com/news/index.ssf/2013/10/obamacare_how_affordable_is_health_insurance_after_the_affordable_care_act.html

Obamacare: How affordable is health insurance after the Affordable Care Act?
on October 20, 2013 at 9:40 AM, updated October 20, 2013 at 10:15 PM

snip

But the uninsured aren’t the only ones who find themselves shopping for a new plan. That’s because the Affordable Care Act requires health insurance plans meet minimum standards and provide many preventive services — like colonoscopies and mammograms — free of charge. That caused insurance companies to rewrite plans and scrap their current offerings for hundreds of thousands of people in New Jersey who buy insurance on the individual and small group market.

Mark Butler and his wife, both 55, are in that group. He is self-employed and she does not work. They had a Horizon EPO plan they liked and paid $746 per month in premiums, but were told their plan won’t exist past their 2014 renewal date.

The cheapest plan Horizon offers on the exchange that covers two 55-year-olds would cost $1,217 per month, a 63 percent increase from what the Flanders couple was paying. That plan, Butler said, only offers 50 percent coinsurance and 50 percent prescription drug coverage, and has a $5,000 family deductible. They could also choose a plan with a $1,546 per month premium that offers a 20 percent coinsurance and $2,000 family deductible.

snip

Eric Stein, 43, of Ridgefield Park is a self-employed chef who had been purchasing his own insurance for several years. He paid $292 in premiums and said he was happy with his plan, which came with no deductible. But that plan did not meet the minimum standards, he was told. A comparable plan will cost him $304 per month and that’s after the $66 subsidy he receives. His copays, he said, went from 0 to $2,500 per month. "I expect that I’m more likely to ration my care because of the high deductible, which kind of defeats the reason of having insurance in the first place," he said.

[geek tragedy]

1. How to spot a fake Obamacare horror story (peddled by rightwingers and trolls)

http://thinkprogress.org/health/2013/10/31/2868631/essential-guide-debunking-obamacare-cost-myth/

1. What does the old plan actually cover? Most of the policies in the existing individual health care market — which are currently issuing notices — offer low premiums, but also come with skimpy benefits and high out-of-pocket costs. These plans often have low limits for outpatient treatment, hospitalization or don’t offer any benefits for procedures like colonoscopy, chemotherapy or mental health treatment. Insurers market these policies to young and healthy people who don’t use their coverage — and never know the true extent of their benefits. (The market is also fairly mobile, with just 17 percent of individual subscribers purchasing the same plan for two years or longer.)

Under the Affordable Care Act, insurers cover 10 essential categories of benefits, offering far more comprehensive coverage than what’s available in most individual insurance plans.

2. Did this person go to the exchanges? Insurers informing policy holders that their health care costs will go up, often direct beneficiaries to their other brand products without telling them about competitive options and prices available through the exchanges. Cavallaro, for instance, got a quote from a broker, but did not explore the available options on her own.

Prices are lowest in areas with the most insurer competition. An analysis from the McKinsey Center for U.S. Health System Reform found that “new entrants into the market make up 26 percent of all insurers,” and “tend to price their plans lower than the median premiums in their market.” The average premium in the exchanges is 16 percent lower than previously projected.

3. Yes, the premium is low, but what are the co-pays and deductibles? This coverage often forces individuals who do use care to meet high deductibles — the amount you pay out-of-pocket before your insurance kicks in — pay high co-pays and co-insurance or limit the number of doctor visits that are allowed. Cavallaro, for instance, must meet a deductible of $5,000 a year and has an out-of-pocket cap of $8,500 a year. The plan covers just two doctors’ visits and each include a $40 co-pay.

As the LA Times’ Michael Hiltzik points out in California, Cavallaro could sign-up for a Silver level plan with a $2,000 deductible, maximum out-of-pocket cost of $6,350, pay $45 for a primary care visit and $65 for a specialty visit — “but all visits would be covered, not just two.”

The health law sets exchange enrollees’ maximum annual out-of-pocket costs at $6,350, and silver plans have deductibles ranging from $1,500 to $5,000.

4. Does this person qualify for subsidies? Americans between 100 and 400 percent of the federal poverty line ($46,000 for an individual, or about $78,000 for a family of three) qualify for tax credits under the law. Six of the 7 million individuals who are expected to sign up for insurance through the exchange will receive an average tax credit of $5,290 per year.

Cavallaro “qualifies her for a hefty federal premium subsidy,” Hiltzik reports and can purchase a silver plan for $333, $40 more than she’s paying now. A cheaper bronze plan would be in the $200s.

[brentspeak]

2. This isn't Fox News; it's the NJ Star-Ledger

And the reporter is not a liar.

[Tanuki]

5. The reporter may not be "a liar", but he is inept and irresponsible

to accept at face value and without further minimal investigation a patently false and ridiculous quote that the man's copays will be $2,500 a month. That is simply not possible.

[brentspeak]

8. He probably meant his deductable, not his copay

Either the person interviewed didn't look at his new policy correctly and relayed the wrong information, or the reporter or his editor screwed up when the article was finished.

[geek tragedy]

10. Yet here you are peddling it as proof that Republicans are right about the ACA.

Despite the obvious sloppiness in the reporting.

What a shockeroo.

[brentspeak]

21. Is the word "Republicans" in my OP?

How about in the link provided?

Maybe somebody peddled a hallucinogen to you, and you're having a reaction.

[dennis4868]

7. plenty of people

who have reported wrongly on this were not lying, They were just getting it wrong, relying on what the consumer was telling them and not looking at all their options on the exchanges.

[wryter2000]

11. Exactly

I have a hard time believing that chef was getting anything he'd "like" for $292/mo if he actually had had to use it. What kind of coverage was he getting for less than $300? We know he wasn't getting free screening.

[geek tragedy]

12. $300 with ZERO copays and ZERO deductible. At 43 years old.

If insurance like that was available on the individual market with decent coverage, there would have been no need to pass any kind of health care reform.

[badtoworse]

3. What about the concept of choice? Low cost and high deductibles is a good fit for some people.

Insurance that protects against catastrophes, but provides less coverage for routine matters is a good option for some. Why should such insurance be unavailable to people that want it?

[geek tragedy]

14. such plans are available to those under 30 and those

who can't afford the bronze plans, per the ACA.

[badtoworse]

15. I'm not sold that ACA was a good idea - we'll just have to see how this plays out

It's starting to look like a lot of people that were happy before are getting hosed now.

[geek tragedy]

17. If you believe misleading press reports that omit key information

and exaggerate the number of people affected, sure it seems like a bad idea.

I mean, if you watch Fox News and read CBS reports filed by Jan "Federalist Society" Crawford and Sharyl "Benghazi!!!!" Atkisson, it's the worst thing ever.

[badtoworse]

18. It's common on DU to decide whether a story is true based solely on who reported it.

A more logical and reasonable approach would be to look at a variety of sources and draw your own conclusions. I do that and I'm having doubts about this program. It looks like there are going to be winners with ACA, but it also looks like there are going to be a lot of losers as well. If someone was happy with their plan and it got cancelled because of ACA, telling them how shitty their old plan was isn't going to change their mind if they have to pay double for a compliant plan.

The bad press seems to be coming from a broad spectrum of political slants, not just Fox News. On another thread, an OP quoted bad press appearing in New Jersey's Star Ledger, hardly a conservative news source.

[geek tragedy]

20. The discussion is of individual market plans, which constiute 6% of all policy holders.

And, of them, some are going to be better off no matter which way you cut it, and some are going to have to pay more for a better plan.

The NJ Star Ledger story was crap.

[SidDithers]

4. Nailed it...nt

Sid

[leftstreet]

6. The article appears to respond to those requirements

Coverage
Exchanges
Copays / Deductibles
Subsidies

[geek tragedy]

9. Neither example describes what's covered.

$292 for an individual plan with $0 deductibles and $0 copay? How could such a wonderful plan fall short of ACA minimum standards?

Answer: lack of coverage.

[uponit7771]

19. coverage isn't described... they were paying ~300 with zero deducitbles

[subterranean]

13. That last paragraph contains an obvious error, or lie.

His copays, he said, went from 0 to $2,500 per month.

That is impossible. First of all, copays are not charged on a monthly basis, they are paid when you visit the doctor or hospital for treatment. And second, they are usually more like $25 for an office visit or maybe $250 for the ER. I've never seen a plan with copays of $2,500.

Probably this was referring to the deductible, but even that is an annual, not a monthly amount.

And he was paying just $292 a month for an individual plan with zero deductible? I find that hard to believe.

[JaneyVee]

16. Slow news day.