The Eye Popping 2016 Obamacare Rate Increases Are Out

[somarco]

Amount billed by carrier is inconsequential.

Talking about billed amounts is like complaining about sticker price for cars or the illustrated price for an airline ticket.

Utilization drives health care costs and in turn premiums.

80% of claims are for treating chronic illness, 70% of chronic illness can be prevented or reversed with lifestyle.

Type II diabetes is rampant along with cardiovascular disease.

VA is single payer.

Medicare, Medicaid is single payer.

How well are those things working and it has nothing to do with provider billed amounts?

 

[Tkruger]

Amount billed by carrier is inconsequential.

Billed amount is what a consumer is faced with if they don't have insurance.

Talking about billed amounts is like complaining about sticker price for cars or the illustrated price for an airline ticket.

Addressed above.

Utilization drives health care costs and in turn premiums.

80% of claims are for treating chronic illness, 70% of chronic illness can be prevented or reversed with lifestyle.

Agreed. However there are those things like accidents and child birth that doo occur.

Type II diabetes is rampant along with cardiovascular disease.

Merica!

VA is single payer.

Diffrent gig that doesn't work either. Surely you've seen the news about the VETs that have died waiting for appointments!

Medicare, Medicaid is single payer.

Medicaid pays most everything. I'm still bringing myself up to speed on Medicare so I can intelligently respond to that.

How well are those things working and it has nothing to do with provider billed amounts?

I think you missed my point. Billed amounts get denied. Fixed rate of pay for services doesn't create competitiveness in our industry. Thus leaving us with what we have now....Failure to communicate.

All a talking point sir.

 

[somarco]

Billed amount is what a consumer is faced with if they don't have insurance.

But they never pay it.

Hospital collections on uninsured typically runs about 15% of billed. Uninsured pay less than those with coverage.

On the flip side where third party reimbursement is involved, traditional insurance pays the most followed by Medicare and Medicaid at the bottom of the list.

Hospitals and facilities that receive govt funding are required to accept Medicare and Medicaid patients. Many docs (not hospital affiliated) do not take any Medicaid pts and most limit the number of Medicare pts to less than 20% of their pt loads.

Most (96%) of docs participate in Medicare but roughly half won't take any Advantage plans.

The only reason M & M work is because of cost shifting to the privately insured pts. If everything is govt paid the system grinds to a halt.

Fixed rate of pay for services doesn't create competitiveness in our industry

The govt side of reimbursement is moving toward pay for performance. After years of providers complaining about SGR formula's they are beginning to find out the new retrospective payment system is a bust.

Some believe consumers will shop for health care if transparency is predominant. Doesn't work that way in reality, only on paper.

Consumers voluntarily shy away from HDHP in favor of copay plans because they don't know how to shop or are too lazy.

Transparency exists for most routine care and even some advanced procedures. Health care blue book is just one example of using data to negotiate pricing if you are uninsured.

But trying to negotiate pricing when you are covered by managed care is fruitless. If you want to shop, many carrier sites have cost estimates built in for the patient that wants to "get a deal" on health care.

But who shops for the lowest cost brain transplant?

No one.

If you really want the lowest cost for major work consider medical tourism.

 

[Yagents]

Affected by O'care increases? depends on where you live:

https://www.cms.gov/Newsroom/MediaR...eets/2015-Fact-sheets-items/2015-10-26-2.html

 

[healther]

Most (96%) of docs participate in Medicare but roughly half won't take any Advantage plans.

You have been saying this since I've started selling MA, can you substantiate your claim?

We have written TONS of MA and this isn't even close to our experience... here is a study that I find to be consistent in SC.

When asked about scheduling timely appointments, beneficiaries in traditional Medicare and those in Medicare Advantage report similar experiences. Specifically, 88 percent of beneficiaries in traditional Medicare and 87 percent of beneficiaries in Medicare Advantage report either "usually" or "always" being able to schedule timely appointments for routine care, according to the 2012 Consumer Assessment of Health Providers and Systems (CAHPS) surveys (Exhibit 2). link

With thousands on the books, we do find holes here and there, but for the most part it's a non-issue... here. Glad I didn't listen to you in the beginning.

 

[dgoldenz]

Affected by O'care increases? depends on where you live:

https://www.cms.gov/Newsroom/MediaR...eets/2015-Fact-sheets-items/2015-10-26-2.html

So incredibly misleading to compare the 2016 SLCS plan to the 2015 one since they could be two different companies and plan networks. Would love to see a comparison of rate increases for the largest company in each state, one on each metal tier. That would be way more representative of the actual marketplace.

 

[Yagents]

Theme of the year:

"Yes mr client, your premium will be higher, deductible higher, network smaller"

Now.....open wide............chooo chooo

 

[healther]

So incredibly misleading to compare the 2016 SLCS plan to the 2015 one since they could be two different companies and plan networks. Would love to see a comparison of rate increases for the largest company in each state, one on each metal tier. That would be way more representative of the actual marketplace.

Blue Cross stole the SLCSP across the board from Consumers' Choice (CCHP) this year... before CCHP "decided" not to offer plans for 2016 last week. Partially due to CCHP rate hikes and Blue plans staying steady, however last year, they weren't very far apart in any county and Blue Cross had the SLCSP in at least half, if not more, of the counties. FWIW