IRS Says, Boom!

[taterpeeler]

subsidies for all!!! I want my free health insurance

oh lordy, run a rate in Austin texas humana and see the new metal plans.

 

[Ann H]

subsidies for all!!! I want my free health insurance

oh lordy, run a rate in Austin texas humana and see the new metal plans.

Well, oh my. Won't you look at that? There are metal tier plans there! Who woulda thunk it? Just like you told me on the phone, Tater!

A family of 4 - parents both age 40, 2 kids ages 6 & 10, zip code 78708

Platinum - $0 deductible - $2852 monthly
Gold - $0 deductible - $2576 monthly
Silver - $0 deductible - $1656
Bronze with a $6,250 deductible - $1034 monthly
Bronze HSA - $4,250 deductible - $925 monthly
And those all say "HMO" on them, and the prescriptions must be filled at Wal-mart.


Contrast that to current traditional plans with a much larger network:
Enhanced Copay 80% plan - $1000 deductible - $788 monthly
Enhanced HSA 100% plan - $5,000 deductible - $516 monthly


On the Bronze at $1034 monthly, the brief summary of benefits says:

Annual deductible of:
$6,250 - you pay $1,034.91/month

Diagnostic illness/injury office visits are included with your plan for a copay for the first 6 visits; there is a $35 copay for a primary care physician visit and a $60 copay for a specialist, $60 for an urgent care visit to a Concentra Clinic and $100 for an urgent care visit to a Non-Concentra Clinic. The plan pays 100% after you pay your deductible for all additional visits
100% coverage for preventive care office visits for primary care physician

Inpatient and outpatient hospital services are paid at 100% after deductible for covered expenses

Prescription coverage included with separate deductible and copays (see details below)


What's the medical deductible?

Individual coverage annual medical deductible: $6,250
Family coverage annual medical deductible: $12,500
Copays do not apply to the deductible
Expenses applied to the medical deductible won't apply to the prescription drug deductible
What's the coverage for preventive care services?

Plan pays 100% on all in-network preventive care services provided by your primary care physician before you have met your deductible. This includes preventive office visits, lab and X-rays.

What's the coverage for diagnostic illness or injury office visits?

For the first 6 visits the plan pays 100% of covered expenses after your $35 copay for office visits to your in-network primary care physician. Copays for in-network urgent care visits to a Concentra Clinic are $60 and Non-Concentra Clinics are $100. Copays for in-network specialists visits are $60 and require a referral from your primary care physician. After your first 6 visits the plan pays 100% after you pay your deductible.

What's the coverage for lab and x-rays?

For diagnostic labs or X-rays during an office visit or urgent care visit the plan covers the first $500 per person then 100% after you pay your deductible.

What's the coinsurance percentage for hospital services?

For in-network inpatient services, once you meet your annual deductible, this plan pays 100% coinsurance for most covered medical expenses from in-network providers. For in-network outpatient services your plan covers the first $500 per person for labs and X-rays and then pays 100% after you pay your deductible.

What's the coverage for emergency room services?

Your plan pays 100% of covered expenses, once you meet your deductible.

Does the plan include prescription drug coverage?

Yes prescription coverage is included with the coverage outline below.

There is a $1,500 deductible which is separate from your medical deductible. The prescription drug deductible does not apply to Level One drugs.
Prescriptions must be filled at Walmart pharmacies or through mail-order service at RightSourceRx.com
If you use an out-of-network pharmacy, there is no coverage
Prescription drug deductibles and copays apply to the plan out-of-pocket maximum
Plan pays 100% for covered services after the plan out-of-pocket maximum is satisfied
Drug levels and copays
$5 copay for Level One: Preferred generics
$25 copay for Level Two: Non-preferred generics
$65 copay for Level Three: Preferred brands
50% for Level Four: Non-preferred brands
50% for Level Five: Specialty drugs
To find out what level your prescription is in, visitHumana.comand select Drug List under Insurance for Individuals​

 

[HealthGuy]

And whos buyin this shiaat ?? Nobody ! hahahaa

 

[Ann H]

One of two possible ingredients are needed now to sink this Titanic:

1. Grass Roots revolt of mammoth proportions that motivates legislators to drastically amend or repeal this monstrosity.

2. States or insurance companies figure out a way for the average middle class person to purchase a non-Obamacare approved health plan, so that those who pay the penalty or are exempt from the penalty will at least have comprehensive coverage. And I'm NOT talking about limited benefit plans!

 

[HealthGuy]

Anybody wanna address anns second point? good point

 

[taterpeeler]

i was rather shocked to see tohse premiums on the humana website like all you guys but i told you all to run the rates in austin, i saw where its availiable in harris county... thats houston one of the more expensive areas... i will run those rate after i get my little tater tots bathed and in the bed
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male, female born in 1970 with 2 13 year olds.... platinum is about 3600 a month silver 2300 a month crapy bronze 1440

that's in Houston, h-town has rates like dallas

yippee!!!

 

[Ann H]

i was rather shocked to see tohse premiums on the humana website like all you guys but i told you all to run the rates in austin, i saw where its availiable in harris county... thats houston one of the more expensive areas... i will run those rate after i get my little tater tots bathed and in the bed
- - - - - - - - - - - - - - - - - -
male, female born in 1970 with 2 13 year olds.... platinum is about 3600 a month silver 2300 a month crapy bronze 1440

that's in Houston, h-town has rates like dallas

yippee!!!

I SURE HOPE THEY PAY US ON A PERCENTAGE OF PREMIUM RATHER THAN PER MEMBER PER MONTH!!! You can pay out a lot of commission on a 20% administrative margin of MLR when you're talking about premiums like that!

Since only the highly subsidized can afford this, I think I'll set up shop in the Wal-mart parking lot.

 

[stuy119]

Stupid question, but what do similar plans run in TX right now? Are those premiums a 100% increase? 50% increase?

I seem to remember that TX health plans were pretty affordable, at least compared to nationwide averages.

Also, I'm going to assume those are non-smoking rates, which could be an additional 50% on top, no?

 

[AllenChicago]

What makes these prices all the more shocking is that the mandated Essential Health Benefits aren't even included yet. No mention of Mental Health, Maternity, etc..

Also, Humana is charging smokers more than the stated 50% rate-up on the metal plans.

Bronze-HMO-Age53-male-Austin, Tx.= $194 Non-Smoker/$318 Smoker.

The standard $1,500 HSA PPO plan for this smoker is $312 @ mo.

I think Humana has come to its senses and is now AGAINST healthcare reform. They want to assist in its self-destruction. What better way than to show current prices on the same page with the "metal" plan prices? A side-by-side graphic is more powerful than a thousand Obama-Sebelius words. GREAT JOB HUMANA!!
-ac
p.s. When I change the zip code to Dallas, 75201, the metal plan prices aren't shown. None for Illinois or Michigan zip codes either. I suppose it's a project in progress.

 

[Dave020]

Anybody wanna address anns second point? good point

Agents. The carriers are free to design any plan outside of the exchange so long as it conforms to a metal tier and contains the EHBs. These plans are not required to be priced in relation to the exchange plans, only the copycat exchange plans sold outside must meet the same premium price point as their inside equivalent.

I would venture the opinion that utilization and claims experience on health plans is similar to experience on auto insurance. Generally, those with low credit ratings consume more P&C coverage (why the carriers run credit rating) and the same may hold true with health insurance.

My wealthier clients (above 400% by quite a lot) always complain about the rate increases because they have not used any benefits on their plan.

133-250% is not the traditional agent's market.

You may see something like Blue Cross Preferred Platinum Co-Pay or Blue Shield Secure Bronze Plus HSA, stuff like that.
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Stupid question, but what do similar plans run in TX right now? Are those premiums a 100% increase? 50% increase?

I seem to remember that TX health plans were pretty affordable, at least compared to nationwide averages.

Also, I'm going to assume those are non-smoking rates, which could be an additional 50% on top, no?

She put it in there, 2 of the current plans co-pay and HSA, $788 and $516 respectively