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Covered California - Prices Rising


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2013 Oct 4, 5:35pm   9,697 views  35 comments

by anotheraccount   ➕follow (1)   💰tip   ignore  

I've finally got a chance to check on the actual prices offered. If I were to switch from my current family plan to the one offered on Covered California, it would be about 15% price increase, not including the crazy co-payments. $50 for an X-ray? X-ray should only cost $20.

Where is Homeboy to defend "lower" prices? Prices are not going down; they are just being subsidized for lower income people. For everyone else, they are going higher.

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1   anonymous   2013 Oct 4, 10:07pm  

My phone rang this morning at 430am. It was obama calling to tell me to get fucked and pay the private health insurance companies what they are owed. He cackled incessantly and I could hear biden in the background sitting in a pile of his own feces, playing with it and calling it chocolate pudding.

We will all sleep well today, knowing that thanks to the democrats, we are that much healthier

2   Homeboy   2013 Oct 5, 6:31am  

treatmentreport says

I've finally got a chance to check on the actual prices offered. If I were to switch from my current family plan to the one offered on Covered California, it would be about 15% price increase, not including the crazy co-payments. $50 for an X-ray? X-ray should only cost $20.

Really? What company are you currently insured with that has a lower premium than what's on the exchange? How much is your deductible and how much does an XRay cost you right now?

3   anotheraccount   2013 Oct 5, 7:08am  

Anthem Blue Cross, My out of pocket max is very similar. I have not gotten X rays, but I got MRIs and they cost me less than $500. Dermatologist visit costs me $72 total (not the co-pay part).

Look, I was hopeful that ACA would bring prices down, but it's not happening. This explains why all the healthcare companies are outperforming this year.

4   Homeboy   2013 Oct 5, 7:17am  

treatmentreport says

Anthem Blue Cross, My out of pocket max is very similar. I have not gotten X rays, but I got MRIs and they cost me less than $500. Dermatologist visit costs me $72 total (not the co-pay part).

Look, I was hopeful that ACA would bring prices down, but it's not happening. This explains why all the healthcare companies are outperforming this year.

So you claim that the co-pay for XRays has gone up, yet you don't know how much they cost before. And you aren't able to tell us what your deductible is? How can you compare two plans if you're not sure if they have the same deductible?

Really, guys?

5   casandra   2013 Oct 5, 7:56am  

From each of tose with abilities to each of those with needs.

Why is this difficult.

Workers will pay for those that don't. It's only fair.

6   anotheraccount   2013 Oct 5, 8:53am  

Homeboy says

So you claim that the co-pay for XRays has gone up, yet you don't know how much they cost before.

I never had an x-ray under Anthem Blue Cross,. My dentist charges $36 for 4 x-rays without insurance which is less than the co-pay under exchange plans.

Homeboy, in three months, it will be clear that they only people that get plans through exchanges are the ones that are getting subsidies and people with pre-existing conditions.

For the rest of us, ACA allowed healthcare prices to rise substantially.

7   Homeboy   2013 Oct 5, 10:03am  

treatmentreport says

I never had an x-ray under Anthem Blue Cross,. My dentist charges $36 for 4 x-rays without insurance which is less than the co-pay under exchange plans.

So then you made that claim that the price of XRays had gone up, and said they "should" cost $20, and your only evidence of that is what your DENTIST charges, and your dentist charges nearly as much as the price you're complaining about. And the fact that you decline to state what your deductible is makes it pretty clear you are not making an apples-to-apples comparison between the 2 plans.

My god, people. I'm willing to admit Obamacare is a failure as soon as someone shows a valid reason to be against it. So far, not a single one of you has done anything expect make shit up. I'm even willing to accept that wealthier people may have to pay a bit more, but so far you haven't even proven THAT.

8   anotheraccount   2013 Oct 5, 10:36am  

Homeboy,

You are dense. I was making a claim about the premium. Right now I am paying $877 for a family of four. The exchange silver plan is $1050 with a higher out of pocket maximum ($12,700) than my plan right now ($10,000)

What else do you want?

My comment about the X-ray is that it's ridiculous that there is a $50 copay when it should only cost $36 max.

9   anotheraccount   2013 Oct 5, 10:39am  

Homeboy,

If I privately show you my statements, are you willing to state publically on Patrick.net that you have been wrong about costs?

10   Homeboy   2013 Oct 5, 5:52pm  

treatmentreport says

You are dense.

So you can't do this without hurling insults. Guess I shouldn't have expected any better.

I'm "dense" because you claimed XRays should be $20, then admitted you didn't know how much you're paying now, then absurdly tried to compare it to what your DENTIST charges (Dentists don't have the same fee schedule as doctors). Then you completely backpedaled and said it should be $36 rather than the $20 you said originally.

I'm trying to have a serious discussion about this, and you're just making shit up and changing your story whenever you feel like it.

treatmentreport says

Right now I am paying $877 for a family of four. The exchange silver plan is $1050 with a higher out of pocket maximum ($12,700) than my plan right now ($10,000)

Out-of-pocket maximum isn't the same as deductible. Out-of-pocket maximum only would come into play if you had some pretty major medical expenses. The deductible is pretty crucial, because you are paying full price for all your medical care until you hit that deductible amount. It would make sense to me to compare plans with the same deductible amount; otherwise your comparison doesn't make any sense. For example, in previous years I have had a zero-deductible plan that cost me $450/month, and at another time had a $10,000 deductible plan that cost $110/month. It makes a huge difference.

But look, it's obviously too taxing for you to have a serious discussion, so go ahead and have your anti-Obama rant with your friends here. I know that's what you guys love to do.

11   Homeboy   2013 Oct 5, 6:06pm  

treatmentreport says

If I privately show you my statements, are you willing to state publically on Patrick.net that you have been wrong about costs?

I'm perfectly happy to take your word here on the forum, as I don't have any reason to believe you are a liar. Is your deductible amount a private thing that you don't wish to divulge? I'm not asking for personal information about you; I just wanted to be able to make a proper comparison between your old plan and what you claim is an "increase".

For the record, I never said I thought premiums were going to go down in 2014. Feel free to do a search of my posts if you don't believe me. I'm not sure what you think I've said that would make me "wrong" if your premium has gone up. I think it's entirely possible that it has, but we won't know that unless you analyze it correctly in an apples to apples comparison, and I don't believe you have done that.

I think some people's rates probably will go up, while others' might go down. This law makes a lot of changes, and that is bound to affect the distribution of rates. What it would take for me to say the law has failed is if the overall average of rates skyrockets, not anecdotal stories of one or two people who are unhappy.

Even if rates increase, so long as they don't increase faster than they did before ACA, then we are better off than we were before. Simply getting rid of pre-existing condition exclusions and getting insurance for the millions of uninsured Americans are laudable goals in and of themselves. Repealing ACA at this point wouldn't do a lick of good. It wouldn't bring prices down and it wouldn't help people get insurance.

12   anotheraccount   2013 Oct 6, 2:09am  

Homeboy,

My individual deductible is 3500 and family is 7000. I don't have any co-payments after deductible. Silver (2000 deductible -1050 per month) and Bronze (5000 deductible -950 per month) plans have co-pays after deductible is reached and that's why I am doing a comparison with out-of-pocket maximum which is lower on my plan. It's not that hard to reach out-of-pocket maximum in bay area if you end up visiting a hospital for anything.

What's important is not just the premium rise from 2013 to 2014. My premiums have been rising over 10% a year every year since ACA was passed. My point that ACA did not address costs that are rising way above inflation. I would have rather seen ACA just shift people that can't afford insurance into Medicare rather than subsidize higher prices. Medicare inflation has been much lower than private insurance.

Some more anecdotal evidence of price shock:

http://www.sfgate.com/health/article/Health-insurance-shoppers-suffer-sticker-shock-4872701.php

13   anotheraccount   2013 Oct 6, 2:53am  

Correction: I do have to pay 20% after deductible, but payments would be smaller that then co-payments. For example, if I got an MRI, my 20% would be less than $100 where as with exchange plans it would be $250 copay under silver plan. The deductible is lower because you pay more after the deductible than on traditional plans. To compare apples to apples, you have to consider out of pocket maximums.

14   Homeboy   2013 Oct 6, 6:53am  

treatmentreport says

My individual deductible is 3500 and family is 7000. I don't have any co-payments after deductible. Silver (2000 deductible -1050 per month) and Bronze (5000 deductible -950 per month) plans have co-pays after deductible is reached and that's why I am doing a comparison with out-of-pocket maximum which is lower on my plan. It's not that hard to reach out-of-pocket maximum in bay area if you end up visiting a hospital for anything.

Ah, now I see why you were feigning obtuse when I asked you what the deductible was. You were comparing your previous plan with a $7000 deductible to the Covered California plan that has only a $2000 deductible. You don't find that just a tad disingenuous to start a thread complaining about alleged rate increases, when EVERYONE KNOWS that plans with lower deductibles are ALWAYS less expensive than plans with higher deductibles? Yet you happily compared two dissimilar plans, ignoring the fact that they aren't even remotely the same coverage, and then pretended not to know what I was asking you when I asked you for the deductible amount. That's just deplorable, dude. I'll give you some points for at least being honest now, but c'mon.

And if you like having a high-deductible, less expensive plan, why on earth would you sign up for the silver plan and not the bronze? And then COMPLAIN about it?

I am now firmly convinced that most people here had already made up their minds that they didn't like ACA before it was even passed, and are hunting for whatever specious and/or contradictory reasoning they can find to support their already-formed conclusion. I'm still willing to consider the law a failure if it doesn't work out, but certainly not on the basis of half-truths and faulty comparisons.

15   Homeboy   2013 Oct 6, 7:08am  

treatmentreport says

I would have rather seen ACA just shift people that can't afford insurance into Medicare rather than subsidize higher prices.

But ACA did shift a lot of low income people to Medicare. Unfortunately, a lot of the red states refused to enact the Medicare expansions, so now those people are screwed. Just more of the "goes too far/doesn't go far enough" paradox.

16   anotheraccount   2013 Oct 6, 7:44am  

Homeboy says

And if you like having a high-deductible, less expensive plan, why on earth would you sign up for the silver plan and not the bronze?

Are you kidding me? My current plan is way better than bronze and still $70 a month cheaper (bronze is 8% more expensive). Silver is 20% more expensive

Obviously, you don't understand why out of pocket maximum is only thing that matters when you have to pay a $250 co-pay for a procedure that only costs $400-500 and would only cost $100 after my deductible. Don't you see that the deductible on ACA plan is not the same as on a normal plan.

I am done arguing with you because you are a cheerleader for ACA no matter what. I suspect by February 2014, we will have statistics on who is signing up for these plans. My guess that it will really apparent at that point that it only makes sense for people that are getting huge subsidies. You are ok with it.

It's like saying for those that can't afford houses, government will pay for it, for everyone else it will be much higher payment.

Homeboy says

But ACA did shift a lot of low income people to Medicare

Medicare and Medicaid are not the same thing. ACA expands Medicaid.

17   anotheraccount   2013 Oct 6, 8:05am  

Homeboy,

Why do you think out of pocket maximums are much higher on ACA plans?

Having a baby in bay area would get you to out of pocket maximum which makes my plan better than bronze and silver plans.

18   Homeboy   2013 Oct 6, 9:08am  

treatmentreport says

Having a baby in bay area would get you to out of pocket maximum which makes my plan better than bronze and silver plans.

How do you figure? Average cost of childbirth is $7500. With your current plan, you'd be responsible for the first $3500 out-of-pocket, then 20% of the rest. With the silver plan, you would only pay the first $2000 out-of-pocket and 20% for the rest.

Your plan: $4300
Silver plan: $3100

Plus, if anyone else in the family gets sick, you have to pay for all of that out-of-pocket as well, whereas with the silver plan, the deductible is already met at the first $2000. That's why lower deductible plans cost more.

19   Homeboy   2013 Oct 6, 9:18am  

treatmentreport says

My current plan is way better than bronze

No it's not. It has a higher deductible than even the bronze plan. Those catastrophic-only plans like the one you have are now a thing of the past. And good riddance to them. Why are people so hell bent on having insurance where you're basically paying full price for everything? I don't get it.

treatmentreport says

Obviously, you don't understand why out of pocket maximum is only thing that matters when you have to pay a $250 co-pay for a procedure that only costs $400-500 and would only cost $100 after my deductible

I don't know what that's supposed to mean. I have never in my life gone all the way to the maximum out-of-pocket expense. That only happens if you have a very serious illness. If you are routinely hitting the $10,000 mark on your out-of-pocket expenses every year, you must have the sickest family in the world. You probably could qualify for disability payments.

What I'm thinking is that you still don't really understand the difference between total out-of-pocket and deductible.

treatmentreport says

Don't you see that the deductible on ACA plan is not the same as on a normal plan.

Huh? You don't understand what a deductible is, do you?

treatmentreport says

I am done arguing with you because you are a cheerleader for ACA no matter what.

Funny, I was thinking YOU'RE a naysayer for ACA no matter what. You're the one who has changed his story several times and at first wouldn't tell us what your deductible was, and finally admitting that it was higher than the ACA plan. I'm just trying to get at the facts; you are bobbing and weaving like Mike Tyson.

20   Homeboy   2013 Oct 6, 9:34am  

Let's say next year you have another child, and one of your kids fell off his bike and broke his arm. That's around $7500 plus another $2000 or so. And those are pretty common things that happen to families. That's $5,500 right there, straight out of your wallet, plus another $800 from the 20% charge. So $6,300.

If you had that silver plan, it's only $2,000 out of your pocket, and the rest is at the 20% charge, so total of $3,500. So under that not-unlikely scenario, you're paying 80% more under your current plan. And the silver plan has a separate deductible for medication; does yours? If not, you're ALSO paying full price for all of your drugs until you hit that $7000 deductible. I just don't understand how you think it's better.

21   anotheraccount   2013 Oct 6, 9:48am  

Homeboy says

If you had that silver plan, it's only $2,000 out of your pocket, and the rest is at the 20% charge, so total of $3,500.

Do you see the part that says that says "Copays in Black are Not Subject to any Deductible and Count Toward the Annual Out-of-Pocket Maximum". All of your calculations ignore co-pays. You are using 20% after deductible which is incorrect and not counting the higher premium costs ($2000 for silver plan).

I gave you an example of MRI co pay which is $250. Under my plan my part is only $100, so you have to add the $150 difference on top of the deductible.

Homeboy says

Average cost of childbirth is $7500

The national average is $8,800 and is much higher in bay area.

22   Homeboy   2013 Oct 6, 10:23am  

treatmentreport says

Do you see the part that says that says "Copays in Black are Not Subject to any Deductible and Count Toward the Annual Out-of-Pocket Maximum". All of your calculations ignore co-pays. You are using 20% after deductible which is incorrect and not counting the higher premium costs ($2000 for silver plan).

O.K., with the silver plan, an ER visit is not subject to the deductible, so then that broken arm I mentioned would probably be CHEAPER. So that makes the plan even better than I thought. How does that help your argument?

I did not ignore co-pays. Co-pays do not come into play until the deductible is met. You're right that I missed ER visits not being subject to the deductible, but as I said, that makes the silver plan BETTER, not worse.

treatmentreport says

You are using 20% after deductible which is incorrect and not counting the higher premium costs ($2000 for silver plan).

This makes no sense. 20% is correct. It's written right there in the image you posted. I don't know what you mean by "not counting the higher premium cost ($2000 for silver plan). $2000 is the DEDUCTIBLE, not the premium cost.

You seem very confused.
treatmentreport says

I gave you an example of MRI co pay which is $250. Under my plan my part is only $100, so you have to add the $150 difference on top of the deductible.

That doesn't make any sense either. You seem to be conflating two different things. Where does it say an MRI co-pay is $250? And how do you figure you only pay 20% now? First you said it was "Under $500", now you are saying it's only $100. You're still changing your story at will. It's really impossible to follow what you're trying to say here.

treatmentreport says

The national average is $8,800 and is much higher in bay area.

O.K., I'll re-do the calculation using your figure:

Average cost of childbirth is $8800. With your current plan, you'd be responsible for the first $3500 out-of-pocket, then 20% of the rest. With the silver plan, you would only pay the first $2000 out-of-pocket and 20% for the rest.

Your plan: $4560
Silver plan: $3360

That doesn't make your plan any better.

23   Tenpoundbass   2013 Oct 6, 11:06am  

treatmentreport says

Prices are not going down; they are just being subsidized for lower income people. For everyone else, they are going higher.

They'll only get subsidized premiums, the poor wont be able to afford to get sick either, so don't kid your self. Don't be like Homeboy.

24   Homeboy   2013 Oct 6, 12:03pm  

CaptainShuddup says

They'll only get subsidized premiums, the poor wont be able to afford to get sick either, so don't kid your self. Don't be like Homeboy.

I just crunched a whole bunch of numbers and showed that's not true. What have you done? You haven't posted a single verifiable fact about ACA, EVER. You don't even know what it's CALLED, LOL. Half the time you write "AHA".

25   anotheraccount   2013 Oct 6, 12:12pm  

Homeboy,

Tell me which part of my analysis you don't agree with (besides likelihood not adding up to 100%).

26   Homeboy   2013 Oct 6, 1:40pm  

treatmentreport says

Homeboy,

Tell me which part of my analysis you don't agree with (besides likelihood not adding up to 100%).

I agree with very little of your "analysis", and that's the parts that even make sense.

Which plan is better IF you don't reach your deductible would depend what the co-pays are, among other things. Since I don't have your plan in front of me, that question can't be answered. I do know that the silver plan has 100% free preventative care and ER visits that are not subject to the deductible, which could save you from a really horrendous ER bill that otherwise you would have to pay full price for. Does your plan offer those things? I don't know.

What your reasoning for saying your plan is "the best" under that scenario is beyond me.

And your claim that going over the deductible but not reaching the out of pocket maximum is a "toss up", is just ridiculous. There is a $5,000 difference in the deductibles. You could conceivably rack up $5000 in costs that you wouldn't have with the silver plan. At the 20% post-deductible rate, that would only be $1000 with the silver plan. So you would save as much as $4000, compared to the only $2076 that you save on premiums with your current plan. How is that a "toss up"? Ridiculous. Besides which, I think it likely that your current insurer would have raised your rates ANYWAY, regardless of whether the California exchange had come into being this year. So what you're REALLY doing is comparing this year's rates to next year's rates, and I don't think that's valid, given that rates generally go up every year.

The only scenario where your reasoning might make any sense at all is if you hit the maximum out of pocket expense EVERY YEAR, in which case you would save $2500 plus the difference in premiums. But if that's really the case, it would make more sense for you to get the platinum plan, which caps out of pocket expenses at only $8,000.

I guess the question is: do you really hit the maximum in out of pocket expenses every year?

27   anotheraccount   2013 Oct 6, 1:52pm  

Don't complicate it.

Scenario 1: If you are healthy and don't reach silver plan's $2000 deductible, my plan is $2000 cheaper.

Scenario 2: You get really sick. My plan is $4500 cheaper ($2000 lower premium and I save $2500 on the out of pocket maximum compared to silver plan).

Scenario 3: I start with $2000 saving. So if you spend $4000 under silver plan, it's still a toss up. I am not even counting the crazy silver plan co-pays.

28   BoomAndBustCycle   2013 Oct 6, 2:37pm  

If affordable care works.... And enough young people sign up. Healthcare plans will have massive surpluses. And since ACA doesnt allow profits greater than 20%... An higher profits will be refunded to all premium payers at the end of the year. So give it a year... Your premium might end up lower than stated. All insurance companies profits are capped as part of ACA.

29   anotheraccount   2013 Oct 6, 2:45pm  

BoomAndBustCycle,

profits does not include massive executive salaries.

30   BoomAndBustCycle   2013 Oct 6, 3:00pm  

treatmentreport says

BoomAndBustCycle,

profits does not include massive executive salaries.

You may be right.... But i got a letter in the mail this year saying profits were higher for Blue Shield Of CA and i would be receiving a refund of a couple hundred bucks. Of course, my employer is probably pocketing this since they run the plan... Even though i pay my dependents premiums in full.

Its a no brainer for me to switch to ACA this year for my wife and newborn child. My works HMO plan, while better, is ridiculously expensive. They cover me in full, but it's $995 a month for my newborn and wife. When it was just my wife it was a more reasonable $425 a month. Thru ACA i can get the both covered on a Platnium Blue Shield PPO plan for $490 a month. Expensive... Sure... But half what my work is taking from my paycheck the last few months of this year.

For me, not insuring my wife and child isnt an option... So ACA just is another option.

31   Homeboy   2013 Oct 6, 6:02pm  

treatmentreport says

Scenario 1: If you are healthy and don't reach silver plan's $2000 deductible, my plan is $2000 cheaper.

Scenario 2: You get really sick. My plan is $4500 cheaper ($2000 lower premium and I save $2500 on the out of pocket maximum compared to silver plan).

Scenario 3: I start with $2000 saving. So if you spend $4000 under silver plan, it's still a toss up. I am not even counting the crazy silver plan co-pays.

This is complete bullshit. Sorry the truth is too "complicated" for you, but that doesn't mean you can just make shit up. I gave you the math, and you just ignored it.

Answer my question: Do you hit the maximum out-of pocket every year? Is this going to be another bob & weave session like with the deductible amount?

32   Homeboy   2013 Oct 6, 6:17pm  

treatmentreport says

BoomAndBustCycle,

profits does not include massive executive salaries.

Of course salaries are included; what are you talking about? Insurance companies aren't allowed to spend more than 15% or 20% of revenue on administrative costs, and salaries most certainly count as administrative costs.

PLEASE stop making things up as you go along.

33   anotheraccount   2013 Oct 7, 12:06am  

Homeboy says

Answer my question: Do you hit the maximum out-of pocket every year? Is this going to be another bob & weave session like with the deductible amount?

I answered you question in my scenario chart. If you can't understand it, I give up.

Homeboy says

PLEASE stop making things up as you go along.

This thing about medical loss ration is the only thing that you might have been right about on this thread. However, as the revenue grows, 20% becomes a bigger and bigger part of the pie.

34   SiO2   2013 Oct 7, 12:55am  

BoomAndBustCycle says

Its a no brainer for me to switch to ACA this year for my wife and newborn child. My works HMO plan, while better, is ridiculously expensive

BABC, before you switch, check on taxes. If you are paying your work hmo premium pre-tax, but would have to pay for ACA after-tax, then the HMO might still be better. Another factor in the mix.

35   Homeboy   2013 Oct 7, 1:51am  

treatmentreport says

I answered you question in my scenario chart. If you can't understand it, I give up.

The question was, do YOU hit your out-of-pocket maximum every year? You did not answer that, you liar. I did not ask you for a "scenario", I asked you a simple, direct question. Before, you were just being disingenuous with your arguments; now you are deliberately withholding the truth. Which indicates to me that you know I'm right.

By the way, didn't you say you were done arguing with me, like a long time ago? LOL.

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