Low-premium, high-deductible health plans are endangered by Affordable Care Act

St. Louis Post Dispatch ^ | August 13, 2013 | MICHELLE ANDREWS

[grundle]

Rod Coons and Florence Peace pay $403 a month for a family health plan that covers barely any medical care for either of them until he or she reaches $10,000 in claims in a given year. And that’s just the way they like it.

“I’m only really interested in catastrophic coverage,” says Coons, 58, who retired last year after selling an electronics manufacturing business in Indianapolis. Beyond their premium, the couple typically spends no more than $500 annually on medical care, Coons says. “I’d prefer to stay with our current plan.”

That won’t be an option next year. In 2014, plans sold on the individual and small-group markets will have to meet new standards for coverage and cost-sharing, among other things. In addition to providing 10 so-called essential health benefits and covering many preventive-care services at no cost, plans must pay at least 60 percent of allowed medical expenses and cap annual out-of-pocket spending at $6,350 for individuals and $12,700 for families.

Coons is none too pleased, either. “I’m happy with where I’m at right now, but it doesn’t look like that’s where I’m going to be at in the future,” he says. Coons plans to look for coverage through the online state marketplace. The couple may qualify for subsidies available to people with incomes up to 400 percent of the federal poverty level ($62,040 for a couple in 2013).

[kidd]

Obamacare is going to open the market for (illegal) off-shore health insurance.

Pay the small fine/tax, but get superior coverage for less money from insurance companies based in Belize.

[jboot]

Thanks for the advice. We have already negotiated with the doctors, and a few of them are providing a limited number of samples, which has helped a lot. Also the pharmacy has a coupon plan that knocks 10% or so off purchases. But with meds costing north of $1000 a month it is only a Band-Aid on the wound. I am concerned that the samples are going to dry up soon, too. One provider has already discontinued them for all patients.

We had an HMO before and were very satisfied with it. I'd take almost anything over this plan.

[Grams A]

I’m right there with many of these people. Sole proprietor and have had the same insurance plan for the last 8 years - $5,000 deductible then 80/20, no networks involved. Monthly premium started out at $275.00, currently at $328.00 until 12/31/2013. Have never used this insurance and purchased only to have something if I needed to go in the hospital. See all my doctors as private pay, cash only. No records, chart notes or billing for the government to stick their nose in. Have been eligible for Medicare for several years but chose to opt out.

Received notice last month that plan was being cancelled and replaced with a lower deductible and “full” coverage for only $857.00 per month.

Looks like I may have to go on Medicare after all. Gave my Rep and Senator an earful and got nowhere.

[Pearls Before Swine]

I have many friends who pay direct for medical care.

If you've got time, that's great. Also, you have to be in an area where providers will do that. Medicare and as I understand, many insurers, won't let providers who work with them cut better private deals with uninsured walk-ins.

[Rick_Michael]

ping

[Plummz]

I have a high-decutible plan also. But I got a letter from my insurance company that my plan is “grandfathered” (since I’ve had it since before 2010) so I won’t be forced into Obamacare.

(Yet.)

[Grams A]

But I got a letter from my insurance company that my plan is “grandfathered”...”

How very fortunate for you. Received notice in the mail today that my “perfect” carrier is closing its doors at the end of this year. I suspect it will be just one of many small companies to do so.

[Harmless Teddy Bear]

Do you have an HSA?

[jboot]

Yes. There is little “extra” money to encash it, though.

[Harmless Teddy Bear]

I understand money being tight but usually it will lower your tax bill enough to be worth it.

Sometimes companies will provide "bonus cash" if you contribute to an HSA as well.

You can also use the fact that you are paying up front to ask for a cash discount. Most places will give them to you. Medical billing is a complicated pain in the assets to most offices. Not having to "file, wait, be rejected, refile, wait, get paid in six to twelve months" is defiantly worth something to the business.

[jboot]

I hear you. The HSA gets cleaned out faster than I can contribute to it. Still, it might help a little at tax time. The company kicked in a little bit-basically the difference in their share of the premium-but we used it in a matter of weeks. These plans are for healthy people.

We tried the discount angle, but since most of our expenses are at the pharmacy it was a non-starter. They bill insurance if there is insurance, period, end of story. We have had no end of frustration with pharmacies. We now have a pharmacy that knows about our insurance and one that doesn't for medicines that are cheaper without insurance. They latter pharmacy really leans on us for insurance info, though. I suspect after Jan 1 they will no longer do any business without seeing an insurance card.

[taildragger]

Some people like these kinds of plans, but now Obama is making them illegal.

Like the...

* Plans College Kids could buy on Campus...
* The McDonald's" Plans....
* Catholic and other faith based plans that don't want Abortion Contraceptive type items in their plans.

This is the One Size fits all mentality. They could have created a structure where HSA's could have been made available to everybody, across state lines and change line 29 on the 1040 to allow anyone to deduct their medical, not just small businesses or get it through your employer.

Instead they went the control route, socialist control.

Worse? Like GM It is the utter distruction of CONTRACT LAW, these are Contracts, that have been eliminated by Federal Fiat. The destruction of Contract Law the last five years is the thing that eveyone misses that Obama and his evil minions have accomplished.

[Harmless Teddy Bear]

For pharmacies it is a non-starter. Sorry, I should have mentioned that. Contact the manufacture of the drugs directly, they usually have a plan for people with chronic conditions and low income. My mom had to take shots monthly for two years. The deductible using insurance would have been well over $350.00 a month. But the drug manufacture had a program and she qualified.

OOP costs for her was $75.00 which fit her budget much better.