ObamaCare Question

[somarco]

Hard to say, Mark. All I can say is wait and see. At least one carrier will only offer child only under rules similar to PCIP . . . cannot have had coverage for at least 6 months.

Tony, I agree with most of what you have posted, but really expect IFP to increase a lot more than 46%. I would expect them to be more like small group rates which are 2x - 3x the rates for comparable IFP plans.

I think I know what you mean by "med check business" but how about clarifying?

Govt subsidies will only exist if the govt has the money to throw at the problem, which is unlikely regardless of the fall elections. Massachusetts is getting about $10 billion per year in federal tax monies to keep RomneyCare afloat. Multiply that by a bunch and you have a big deficit hole to deal with.

 

[LGilmore]

From what I am seeing and hearing in my neck of the woods is price is taking a real healthy 25%+ jump in 2013 to prepare for 2014. Our OIC has told insurers to be compliant by Jan 2013. In other words be ready a year early.

Some are trying, others, our BC provider decided to drop all it's small group choices but one. A 5k deductible 12k out of pocket (not including deductible) and deductible has to be met first for RX to kick in. Very cheap premiums, but I don't forsee many small business buying it. They've sort of designed themselves out of the market. They can't say we won't offer a product, they can just make it sooo s hity that nobody buys it. That is one way to participate in the big change.

 

[AllenChicago]

The 10 Essential Health Benefits that every non-grandfathered Major Medical policy (both exchange and non-exchange) must include, starting in 2014, will really ramp up premiums. One of the 10 benefits is Maternity Coverage, even if no women are on the policy. We all know how expensive maternity coverage is.

Ref: States Moving Ahead On Defining

You add in the Guaranteed Issue, No Exclusions Allowed provisions of ACA, along with the hefty new premium tax that all health insurers will have to start paying to the IRS in 2014 and it's likely that even today's group plans will look like bargains by comparison.

As was pointed out earlier in this thread, it will be really hideous for people age 0 to 30. They will likely be paying as much as a 50 year old pays today.

The highly touted Federal Subsidies to help people pay their premium are at the maximum $$$ amount for those who are just above Medicaid eligibility. The subsidy steadily decreases as income rises... down to $11 a month for an individual who is age 40 earning $46,000 per year. Eleven dollars to help this person pay a $400 monthly premium.

Ref: Health Reform Subsidy Calculator - Kaiser Health Reform

Policies sold outside of the Exchanges must have the 10 Essential Health Benefits, but don't have to be Guaranteed Issue/Exclusion-Free. They will cost more than today's plans, but less than Exchange health policies.

Everything above is just my guess and opinion from all the good materials available in this forum and elsewhere.
-ac

 

[Yagents]

Allen, metal plans in and outside the exchange will be the same price, and will also be GI in and out of exchange. Otherwise, you have serious adverse selection problems.

You could feasibly get a $0 premium, but would have to be at 134% poverty level, too rich for free Medicaid, but poor enough to get heavily subsidized for bronze since subsidies are based upon silver pricing.

People at certain breakpoints of FPL, will be begging not to get a raise. The additional income will be lost in higher taxes and reduced subsidies.

 

[somarco]

Policies sold outside of the Exchanges must have the 10 Essential Health Benefits, but don't have to be Guaranteed Issue/Exclusion-Free.

Got a source for that? I have not seen that anywhere

 

[AllenChicago]

Got a source for that? I have not seen that anywhere

Certainly Somarco, here's wording that's contained in the Kaiser Health News link from my post you're referencing...

"Essential benefit requirements apply to individual and small group plans sold within and outside the new online, state-based exchanges scheduled to launch in 2014."

Here's the source link once again. Source: States Moving Ahead On Defining

When HHS mandated that Preventive Care be added to all policies issued retroactively, back to 3/23/2010, it didn't have a big effect on premium. Is it likely that HHS will require that the 10 EHB's be included in all policies dating back to 3/23/2010? If so, price the increase would be significant... particularly so, as full maternity coverage is one of the 10 benefits.
-ac

 

[somarco]

No, not the essential benefits. The statement that plans outside the exchange don't have to be GI.

 

[Ann H]

Answer to Question # 1 - Yes, plans both inside and outside of the exchange must be guarantee issue after 1/1/2014.

Question #2 -

Is it likely that HHS will require that the 10 EHB's be included in all policies dating back to 3/23/2010? If so, price the increase would be significant... particularly so, as full maternity coverage is one of the 10 benefits. -ac

Answer to Question #2 -
From http://cciio.cms.gov/resources/files/largest-smgroup-products-7-2-2012.pdf.PDF

Non-grandfathered plans in the individual and small group markets both inside and outside of the Exchanges along with certain other types of plans must cover EHBs beginning in 2014. 1 Section 1302(b)(1) of the Affordable Care Act provides that EHB include items and services within 10 statutorily defined benefit categories. Section 1302(b)(2) instructs the Secretary that the scope of EHB shall equal the scope of benefits provided under a typical employer plan.

1 Self-insured group health plans, health insurance coverage offered in the large group market, and grandfathered health plans are not required to cover the essential health benefits.
​

So, if you mean by "require that the 10 EHB's be included in all policies dating back to 3/23/2010?" that non-grandfathered plans, including those sold between 3/23/2010 and 12/31/2013, must be updated to include all 10 EHB's, then the answer is "yes, on 1/1/2014". If you mean that that the benefits must be backdated to 3/23/2010, then the answer is "no".

Question #3 that wasn't asked, but probably should have been... "Will the non-grandfathered plans have to be updated to meet at least the bronze level of actuarial value?"

Answer - On 1/1/2014, non-grandfathered plans must meet the "minimum benefits" or "actuarial value" tiers of bronze, silver, gold or platinum.
From http://cciio.cms.gov/resources/files/Files2/02242012/Av-csr-bulletin.pdf

The Affordable Care Act requires issuers offering non-grandfathered health plans inside and outside of the Exchange in the individual and small group markets to assure that any offered plan must meet distinct levels of coverage specified in section 1302, called "metal tiers" -- bronze, silver, gold, or platinum.3 Under the statute, each metal tier corresponds to an AV, calculated based on the cost-sharing features of the plan as described above. The expression of AV as a metal tier will allow consumers to easily compare plans based on cost-sharing features.
​

So, add these together - guarantee issue, no pre-existing conditions waiting periods, 10 essential health benefits (including full maternity coverage), gender neutral rating, 1:3 age banding ratios, rich coverage where the bronze level is richer than most IFP plans today - and what do you have? My prediction is that it will cause IFP premiums to double, and ultimately probably triple the prices that an average IFP consumer today pays. Maybe quadruple for those on an HSA or $10,000 deductible type of plan currently.

 

[somarco]

My prediction is that it will cause IFP premiums to double, and ultimately probably triple the prices that an average IFP consumer today pays. Maybe quadruple for those on an HSA or $10,000 deductible type of plan currently.

We are pretty much in agreement on this.

Hoping my commissions triple as well . . .

 

[AllenChicago]

Answer to Question # 1 - Yes, plans both inside and outside of the exchange must be guarantee issue after 1/1/2014.

Ann, thanks for answering Somarco's question. I had incorrectly believed that Major Meds sold outside of the Exchange(s) did NOT have to be Guaranteed Issue/Exclusion-Free. Overall, yet another VERY good an informative post from Ann H.!
-ac