"Health Affairs" Says Most Indiv Plans Not ACA Compliant.

[AllenChicago]

Yes...yet another study has been published that speaks badly of today's individual health insurance policies and their compliance with Affordable Care Act regulations. The problem is that the study conclusion is full of double-talk and outright lies.

REF: Study: Most individual insurance plans fall short of health law's standards - The Hill's Healthwatch

How can an insurance policy cover at least 60% of costs if most people don't meet their deductible each year? I suppose the numbers would look better if everyone met their deductibe by getting sick, contracting a disease, or being badly injured.

Also, in the first part of the article, it states that Individual Plans cost more than Group plans (huge lie), because they provide fewer benefits. Yet near the end of the article, the study says that Exhange policies will cost more because they have richer benefits.

The "Health Affairs" organization must be in the middle of a fund-raising drive and simply did this study to increase their exposure to the public. Very little thought went into it, IMO.
-Allen

 

[Yagents]

Allen, in some states, IFP is actually higher than group (NJ for example), but in most states outside of the beltway, IFP is cheaper (like FL and AZ). We also know it's cheaper because it covers less, and has less mandates. No maternity, no mental health, etc.

The actuarial value part of this mathematical nightmare is too difficult to figure out, but just know that free prev care and copays will make up for a lot of any projected outlay of costs to put towards the 60%. Then, look for low deductible plans, or even $0 deductibles then 60/40 coinsurance type plans. This is why HSA's are in danger.

Obama's plan makes you buy a richer plan at a richer price. That's why I say watch for your book to explode for any NON GF plan with over $6k OOP per person. They will be mandated to upgrade, and pay much higher premium

 

[somarco]

They will be mandated to upgrade

I have never seen that in Obamacare legislation. Can you point me in the right direction?

 

[Guest]

I have never seen that in Obamacare legislation. Can you point me in the right direction?

Somarco: you don't take pms so I just wanted you to know I sent you and Mark a linkedin request. I respect ya'lls opinions and would love to speak with you more. Angela

 

[Yagents]

I have never seen that in Obamacare legislation. Can you point me in the right direction?

Of course they can drop the plan and pay the penalty if required to upgrade. This came from Ins Co. executive, but just confirmed by suspicions. I don't like reading the actual law, but just look to parts of the law which ties out of pocket limits to HSA limits. Anything that is NON GF, must adhere to these limits and add maternity, etc.

 

[GreenSky]

I have never seen that in Obamacare legislation. Can you point me in the right direction?

Here's the link you need to discuss this legislation. Now that it's been passed I'm pretty sure she knows what's in it.

Representative Nancy Pelosi | Representing the 8th District of California

Rick

 

[ABC]

GI alone will increase the individual market 300%.

Now add in the essential benefits with and actuarial value and the rates could be 500% higher than what they are now.

If the law stays on the books our health care system will look like Germany. 90% of the population in the Pool and the top 10% with private coverage.

 

[Ann H]

I have never seen that in Obamacare legislation. Can you point me in the right direction?

I was under the impression all non-grandfathered plans must meet essential benefits or terminate, but what do I know... The longer PPACA remains alive the less I remember about the details! Finding that language to support my theory was hard. I found a couple of documents about it. According to the NAHU:

Requirements Effective Beginning 2014
Of the nongroup and small group market reforms effective in 2014, the following apply both
inside and outside of exchanges:
• Cost of health insurance coverage must abide by adjusted community rating rules. Rates may not vary based on health factors. Rates may vary only by (1) age (by no more than a 3:1 ratio across age rating bands established by the Secretary), (2) tobacco use (by no more than 1.5:1 ratio, (3) self-only or family enrollment, and (4) rating area (as specified by the state)
.
• Coverage must be offered on a guaranteed issue and guaranteed renewal basis.

• Eligibility for health insurance coverage may not be based on health factors.

• Employer-sponsored (group) coverage cannot have waiting periods greater than 90 days.

• Qualified individuals may not be denied participation in clinical trials.

• Coverage must include the "essential health benefits package" as required
under §1302(a) of PPACA, which requires plans to do the following three things:
• cover essential health benefits;
limit annual cost-sharing to the thresholds applicable to high-deductible
health plans (HDHPs) that are qualified for Health Savings Accounts
(HSAs)—and additionally for small group plans, limit deductibles to no
more than $2,000 for self-only coverage, or $4,000 for any other coverage in
2014 (annually adjusted thereafter); and
• standardize benefit packages into specified bronze, silver, gold, and/or
platinum levels of coverage.

• Issuers must consider all enrollees in all nongroup plans offered by the issuer as members of a single risk pool, including enrollees in a nongroup plan outside an
exchange. Issuers must also do the same for all their small group plans. States may also merge their individual and small group markets, requiring issuers to have a single risk pool combining both the nongroup and small group enrollees.

• All insurers (including third-party administrators of self-insured plans) must contribute to a temporary reinsurance program for individual policies that will
be administered by a nonprofit reinsurance entity in each state. Each state must establish the reinsurance program for the individual market by no later than
January 1, 2014, with it lasting through 2016.

• All insurers must participate in risk-adjustment programs that states are required to establish, in which plans with enrollment of less-than-average risk
will pay an assessment to the state, and states will provide payments to plans with higher-than-average risk.
​

http://www.nahu.org/legislative/res...th Ins Inside V Outside Exchanges_June 10.pdf on page 4.

I also read a Congressional Research Service description of PPACA requirements and on page 16 it says:

Require QHPs and issuers in the individual and small group markets to offer coverage that includes the "essential health benefits package" (see description
below).
​

This government document entitled "Private Health Insurance Provisions in PPACA (P.L. 111-148)" is maddening! The Table Of Contents showed a "Leveling the Playing Field" section, so I went there and found on page 19:

Levels of Coverage
Beginning in 2014, PPACA will generally require QHPs to provide coverage at one of the following levels: bronze, silver, gold, or platinum. This requirement will apply regardless of whether or not the QHP is offered through an exchange (and premiums must be the same for QHPs inside and outside of the exchange).
​

Although maddening, this is a document we should all read, to update ourselves on the requirements of PPACA - well maybe wait until after SCOTUS rules! http://www.bingaman.senate.gov/policy/crs_privhins.pdf

 

[somarco]

Ann, thanks for the info and link. Believe I will wait on SCOTUS and/or the fall election before reading.

I am sure there are many more surprises yet to come, depending on the whims of Madamn Shebullshits.

There will probably be more lawsuits, such as the one filed by 43 Catholic organizations a few days ago.

 

[Ann H]

Ann, thanks for the info and link. Believe I will wait on SCOTUS and/or the fall election before reading.

I am sure there are many more surprises yet to come, depending on the whims of Madamn Shebullshits.

There will probably be more lawsuits, such as the one filed by 43 Catholic organizations a few days ago.

You're right. And, even if we come to year 2014 with PPACA in force, it's unlikely this thing will be implemented on that time schedule anyway. So far, pert near everything has been delayed, waived, repealed or greatly altered when the time for implementation has come.