California affordable care act rates for 2014 released

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hicabob
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California affordable care act rates for 2014 released

Post by hicabob » Thu May 23, 2013 1:28 pm

http://www.coveredca.com/news/press-rel ... unced.html


"The rates submitted to Covered California for the 2014 individual market ranged from two percent above to 29 percent below the 2013 average premium for small employer plans in California’s most populous regions. This is impressive since the 2014 products include doctor visits, prescriptions, hospital stays and more essential benefits; protecting consumers from the "gimmicks and gotchas" of many insurance policies."

BruDude
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Re: California affordable care act rates for 2014 released

Post by BruDude » Thu May 23, 2013 1:42 pm

"Virtually every health plan designed a custom network for Covered California. Negotiations included a detailed review of each plan’s rates, their mix of hospitals, physicians and other providers, and their contingency plans for expanding networks in the event more consumers sign up than expected."

In other words, the networks for many companies will be local instead of national. Aetna, Cigna, and United Healthcare are noticeably absent from the list. Anthem, Blue Shield, HealthNet, and Kaiser are the only recognizable names on that list, and most people will gravitate towards Anthem and Blue Shield. Comparing a plan with a $6,350 OOP max to the "average small group health plan" doesn't make much sense since the small group plans probably have a much lower OOP maximum. Will be curious to see what the family rates and rates for ages 20-35 look like.

SimonJester
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Re: California affordable care act rates for 2014 released

Post by SimonJester » Thu May 23, 2013 1:56 pm

Outch so about $850 per month, vs $175 today hmmm I think not...
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gerrym51
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Re: California affordable care act rates for 2014 released

Post by gerrym51 » Thu May 23, 2013 2:03 pm

I think what you are most likely to see is that insurance companies will offer plans based on how much insurance they already do in an area. i doubt you will see providers go into a market they are not already in


i did see 25 dollar generic co-pays on the cheapest plans. i am in the rx business and i have never seen a 25 dollar generic drug co-pay that is high

orlandoman
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Re: California affordable care act rates for 2014 released

Post by orlandoman » Thu May 23, 2013 2:14 pm

gerrym51 wrote:I think what you are most likely to see is that insurance companies will offer plans based on how much insurance they already do in an area. i doubt you will see providers go into a market they are not already in


i did see 25 dollar generic co-pays on the cheapest plans. i am in the rx business and i have never seen a 25 dollar generic drug co-pay that is high

An option for many nationwide is retailers like Walmart & Target which both have a lists of 100's of generic prescriptions that they offer for $4. FYI, here's Walmart's list: http://www.walmart.com/cp/PI-4-Prescriptions/1078664
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Jack
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Re: California affordable care act rates for 2014 released

Post by Jack » Thu May 23, 2013 2:17 pm

SimonJester wrote:Outch so about $850 per month, vs $175 today hmmm I think not...
Your information may be in error. Make sure you are comparing apples to apples.

For a 21-year-old:
Catastrophic coverage -- $136
Bronze coverage -- $172
Silver coverage -- $216

For a 40-year-old:
Bronze coverage -- $219
Silver coverage -- $276

These are the average rates for the entire state. There are regional differences. Rates are for the lowest cost provider. Rates may be higher if you select a higher cost provider. These are for single individuals.
Last edited by Jack on Thu May 23, 2013 2:24 pm, edited 1 time in total.

gerrym51
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Re: California affordable care act rates for 2014 released

Post by gerrym51 » Thu May 23, 2013 2:23 pm

orlandoman wrote:
gerrym51 wrote:I think what you are most likely to see is that insurance companies will offer plans based on how much insurance they already do in an area. i doubt you will see providers go into a market they are not already in


i did see 25 dollar generic co-pays on the cheapest plans. i am in the rx business and i have never seen a 25 dollar generic drug co-pay that is high

An option for many nationwide is retailers like Walmart & Target which both have a lists of 100's of generic prescriptions that they offer for $4. FYI, here's Walmart's list: http://www.walmart.com/cp/PI-4-Prescriptions/1078664

thats not the point-by instituting a 25 dollar generic co-pay-because 80 percent of prescriptions are generic(most insurance demands generics if available) these plans have basically eliminated most prescription insurance costs to the plans

BruDude
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Re: California affordable care act rates for 2014 released

Post by BruDude » Thu May 23, 2013 2:26 pm

Using rates from the lowest cost company is a bit disingenuous when some of these networks only have a few hundred doctors (compared to national PPO's with hundreds of thousands of providers)...I don't know anyone that would want to buy a health insurance policy with so few providers.

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Re: California affordable care act rates for 2014 released

Post by Jack » Thu May 23, 2013 2:39 pm

BruDude wrote:Using rates from the lowest cost company is a bit disingenuous when some of these networks only have a few hundred doctors (compared to national PPO's with hundreds of thousands of providers)...I don't know anyone that would want to buy a health insurance policy with so few providers.
Okay, you prefer the highest cost plans? (Parentheses contain lowest cost plan for comparison.)

For a 21-year-old:
Catastrophic coverage -- $168 ($136)
Bronze coverage -- $185 ($172)
Silver coverage -- $230 ($216)

For a 40-year-old:
Bronze coverage -- $236 ($219)
Silver coverage -- $299 ($276)

Blue Cross network covers over 800 hospitals and over 100,000 physicians.

Oops, that should be Blue Shield not Blue Cross.
Last edited by Jack on Thu May 23, 2013 2:46 pm, edited 1 time in total.

mlipps
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Re: California affordable care act rates for 2014 released

Post by mlipps » Thu May 23, 2013 2:40 pm

BruDude wrote:Comparing a plan with a $6,350 OOP max to the "average small group health plan" doesn't make much sense since the small group plans probably have a much lower OOP maximum. Will be curious to see what the family rates and rates for ages 20-35 look like.
I don't know that that's necessarily true. Both my parents work for small employers & have deductibles & OOP in that ball park. My mom's doesn't even have an HSA attached to it. They both have major ongoing medical expenses that are pushing 10%+ of their annual income that are not covered by insurance due to the high deductibles.

gerrym51
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Re: California affordable care act rates for 2014 released

Post by gerrym51 » Thu May 23, 2013 2:45 pm

mlipps wrote:
BruDude wrote:Comparing a plan with a $6,350 OOP max to the "average small group health plan" doesn't make much sense since the small group plans probably have a much lower OOP maximum. Will be curious to see what the family rates and rates for ages 20-35 look like.
I don't know that that's necessarily true. Both my parents work for small employers & have deductibles & OOP in that ball park. My mom's doesn't even have an HSA attached to it. They both have major ongoing medical expenses that are pushing 10%+ of their annual income that are not covered by insurance due to the high deductibles.

i'm 62 and live in massachusetts and buy from the health connector from which obamacare is copied.

i pay 575 a month with 2000 deductible and total of 4000 out of pocket-thought that might give perspective

BruDude
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Re: California affordable care act rates for 2014 released

Post by BruDude » Thu May 23, 2013 2:47 pm

mlipps wrote:
BruDude wrote:Comparing a plan with a $6,350 OOP max to the "average small group health plan" doesn't make much sense since the small group plans probably have a much lower OOP maximum. Will be curious to see what the family rates and rates for ages 20-35 look like.
I don't know that that's necessarily true. Both my parents work for small employers & have deductibles & OOP in that ball park. My mom's doesn't even have an HSA attached to it. They both have major ongoing medical expenses that are pushing 10%+ of their annual income that are not covered by insurance due to the high deductibles.
In the states that I sell in, a $6000+ OOP max for an individual is not very common on group plans. Most plans limit the OOP max to $2-4k for individuals.
Jack wrote:
BruDude wrote:Using rates from the lowest cost company is a bit disingenuous when some of these networks only have a few hundred doctors (compared to national PPO's with hundreds of thousands of providers)...I don't know anyone that would want to buy a health insurance policy with so few providers.
Okay, you prefer the highest cost plans? (Parentheses contain lowest cost plan for comparison.)

For a 21-year-old:
Catastrophic coverage -- $168 ($136)
Bronze coverage -- $185 ($172)
Silver coverage -- $230 ($216)

For a 40-year-old:
Bronze coverage -- $236 ($219)
Silver coverage -- $299 ($276)

Blue Cross network covers over 800 hospitals and over 100,000 physicians
I would just use Anthem and Blue Shield's rates for reference since they are going to control most of the market. I don't sell in CA but those rates are about double what the rates are for individuals in the states that I sell.

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bottlecap
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Re: California affordable care act rates for 2014 released

Post by bottlecap » Thu May 23, 2013 2:50 pm

Well, I gather from the article that the director of Covered California thinks Covered California is giving away a great deal to Californians. At least that's what he and the employee of Covered California wrote on its website. Maybe it is, but the article is little more than one of those "paid advertisement" faux articles you see in magazines.

Stay tuned, I guess.

JT

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Re: California affordable care act rates for 2014 released

Post by Jack » Thu May 23, 2013 3:10 pm

BruDude wrote:I don't sell in CA but those rates are about double what the rates are for individuals in the states that I sell.
You don't sell in CA, then your statement is meaningless. Seriously, you expect us to believe that Cigna and Aetna could provide insurance in CA for half the price? Then why don't they just go in at a 10% discount and run everyone out of business and clean up on the 40% extra?

I've priced Aetna and Cigna for individual coverage recently and they are by far the highest. Not even close to Blue Cross or Blue Shield. In fact, from what I have seen, Aetna and Cigna are backing out of individual coverage in many states where they are uncompetitive.

BruDude
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Re: California affordable care act rates for 2014 released

Post by BruDude » Thu May 23, 2013 3:21 pm

Jack wrote:
BruDude wrote:I don't sell in CA but those rates are about double what the rates are for individuals in the states that I sell.
You don't sell in CA, then your statement is meaningless. Seriously, you expect us to believe that Cigna and Aetna could provide insurance in CA for half the price? Then why don't they just go in at a 10% discount and run everyone out of business and clean up on the 40% extra?

I've priced Aetna and Cigna for individual coverage recently and they are by far the highest. Not even close to Blue Cross or Blue Shield. In fact, from what I have seen, Aetna and Cigna are backing out of individual coverage in many states where they are uncompetitive.
Don't know where you read in my post that Aetna and Cigna would be half the price....I was just saying it's interesting that three of the largest health insurance companies in the US have opted not to sell in the largest single health insurance market in the US. Aetna and Cigna aren't competitve in my markets either, but they are in some states.

Given that CA rates on the individual market were roughly the same as the states I sell, the fact that these rates are about double is not meaningless. These are also the initial rates, which could see big changes as the claims experience is realized for these new insureds. I'll bet the smaller companies on the list either won't exist or will stop selling within 5 years. I don't see how they can compete with the larger carriers, especially since agents are not going to be likely to sell their products and they will have higher fixed overhead expenses and will have a tough time meeting the 80% MLR requirement.
Last edited by BruDude on Thu May 23, 2013 3:23 pm, edited 1 time in total.

Batousai
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Re: California affordable care act rates for 2014 released

Post by Batousai » Thu May 23, 2013 3:21 pm

I find it interesting to finally see rates, even if they're not in my market.

gerrym51
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Re: California affordable care act rates for 2014 released

Post by gerrym51 » Thu May 23, 2013 3:27 pm

BruDude wrote:
Jack wrote:
BruDude wrote:I don't sell in CA but those rates are about double what the rates are for individuals in the states that I sell.
You don't sell in CA, then your statement is meaningless. Seriously, you expect us to believe that Cigna and Aetna could provide insurance in CA for half the price? Then why don't they just go in at a 10% discount and run everyone out of business and clean up on the 40% extra?

I've priced Aetna and Cigna for individual coverage recently and they are by far the highest. Not even close to Blue Cross or Blue Shield. In fact, from what I have seen, Aetna and Cigna are backing out of individual coverage in many states where they are uncompetitive.
Don't know where you read in my post that Aetna and Cigna would be half the price....I was just saying it's interesting that three of the largest health insurance companies in the US have opted not to sell in the largest single health insurance market in the US. Aetna and Cigna aren't competitve in my markets either, but they are in some states.
the only way to have real competative prices in a state is to already have major networks in a state. then you can use an existing network with some restrictions and offer a lower price. voila! i doubt you will see an insurer go into a market that they don;t already have a big presence in. Unitedhealthcare(i think it was them) recently bought one of the biggest multi state medicaid providers. they can use this company(in states that they have big networks already) to craft networks for the exchange plans

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Re: California affordable care act rates for 2014 released

Post by madbrain » Thu May 23, 2013 3:36 pm

gerrym51 wrote: thats not the point-by instituting a 25 dollar generic co-pay-because 80 percent of prescriptions are generic(most insurance demands generics if available) these plans have basically eliminated most prescription insurance costs to the plans
Where did you see the info about the $25 generic ?
I agree that it is high. But was it for one week, one month, one year ?

HIV meds for myself and my partner cost about $5000 a month. Those would be a big expense to the plans still.
It would take quite a few generic prescriptions to make up for those.
So, I don't think they eliminated "most prescription insurance costs to the plan". A chunk of them, yes, but not most.

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Re: California affordable care act rates for 2014 released

Post by gerrym51 » Thu May 23, 2013 3:44 pm

madbrain wrote:
gerrym51 wrote: thats not the point-by instituting a 25 dollar generic co-pay-because 80 percent of prescriptions are generic(most insurance demands generics if available) these plans have basically eliminated most prescription insurance costs to the plans
Where did you see the info about the $25 generic ?
I agree that it is high. But was it for one week, one month, one year ?

HIV meds for myself and my partner cost about $5000 a month. Those would be a big expense to the plans still.
It would take quite a few generic prescriptions to make up for those.
So, I don't think they eliminated "most prescription insurance costs to the plan". A chunk of them, yes, but not most.
this pdf file-4th page down right hand side. AND PAGE 5 LEFT HAND SIDE

http://www.coveredca.com/news/PDFs/CC_H ... ooklet.pdf


i did not say eliminate all-but a 25 dollar generic co-pay eliminates quite a bit


i also said i'm in the business-yes your drugs are expensive-there are also other expensive drugs-but the expensive drug users are a very small percentage although the dollar figure is much higher but 80 percent of scripts in this country are generic-you eliminate all these from the rx coverage and an insurance companies on the exchange rx bill is cut probably by 60 percent compared to other plans
Last edited by gerrym51 on Thu May 23, 2013 4:31 pm, edited 2 times in total.

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magellan
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Re: California affordable care act rates for 2014 released

Post by magellan » Thu May 23, 2013 3:47 pm

BruDude wrote:....I was just saying it's interesting that three of the largest health insurance companies in the US have opted not to sell in the largest single health insurance market in the US.
I'm no expert on this, but some quick googling produced this LA Times article that shows that for 2011, Kaiser Permanente had 40% of the market in CA, followed by Anthem with 23%, 14% for Blue Shield, 9% for Health Net, and 5% for United Health.

Kaiser is a non-profit, so perhaps they're the Vanguard of health insurance in CA and they make the market less lucrative for outside for-profit firms.

Jim

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frugaltype
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Re: California affordable care act rates for 2014 released

Post by frugaltype » Thu May 23, 2013 4:10 pm

gerrym51 wrote: i did see 25 dollar generic co-pays on the cheapest plans. i am in the rx business and i have never seen a 25 dollar generic drug co-pay that is high
Did you mean to say you had never seen a generic drug co-pay as high as $25? I fork out $200-$300 a month for the generic for Rythmol 325 mg twice a day.

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Re: California affordable care act rates for 2014 released

Post by gerrym51 » Thu May 23, 2013 4:16 pm

frugaltype wrote:
gerrym51 wrote: i did see 25 dollar generic co-pays on the cheapest plans. i am in the rx business and i have never seen a 25 dollar generic drug co-pay that is high
Did you mean to say you had never seen a generic drug co-pay as high as $25? I fork out $200-$300 a month for the generic for Rythmol 325 mg twice a day.

thats not a co-pay thats a price- are you saying your insurance companies co-pay for this generic is 300 dollars. are you sure thats not the deductible. some insurance plans have a prescription deductible that has to be met before insurance actually starts.

i have never seen a generic co-pay more than 10 dollars that i recall. and i have filled thousands of generic rx.

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Re: California affordable care act rates for 2014 released

Post by Jack » Thu May 23, 2013 4:21 pm

BruDude wrote:I don't sell in CA but those rates are about double what the rates are for individuals in the states that I sell.
Given that CA rates on the individual market were roughly the same as the states I sell, the fact that these rates are about double is not meaningless.
I'm having difficulty parsing these statements. You seem to be saying the new California rates are twice as high as the rates in the states you sell. And also saying that previously the California rates were the same as the states you sell. Yet the current California rates are lower than they were before the exchange was established.

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Re: California affordable care act rates for 2014 released

Post by madbrain » Thu May 23, 2013 4:32 pm

gerrym51 wrote:
this pdf file-4th page down right hand side.

http://www.coveredca.com/news/PDFs/CC_H ... ooklet.pdf
Thanks !
i did not say eliminate all-but a 25 dollar generic co-pay eliminates quite a bit
Right, most generic prescriptions would cost under $25. But you would end up paying the actual drug price in that case if the copay is higher.
At least, that's the case with my Kaiser plan.

One thing that's disconcerting is that there is no copay listed for brand name drugs.

If you look at page 5, you will see that there are platinum plans with much lower copays.

gerrym51
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Re: California affordable care act rates for 2014 released

Post by gerrym51 » Thu May 23, 2013 4:39 pm

madbrain wrote:
gerrym51 wrote:
this pdf file-4th page down right hand side.

http://www.coveredca.com/news/PDFs/CC_H ... ooklet.pdf
Thanks !
i did not say eliminate all-but a 25 dollar generic co-pay eliminates quite a bit
Right, most generic prescriptions would cost under $25. But you would end up paying the actual drug price in that case if the copay is higher.
At least, that's the case with my Kaiser plan.

One thing that's disconcerting is that there is no copay listed for brand name drugs.

If you look at page 5, you will see that there are platinum plans with much lower copays.
the 25 dollar copay lowers costs to the plan-they don't care what you pay-they care what they pay

the main plans are based on silver. yes if you buy a gold or platinum plan the co-pay is less. it better be because you are choosing to pay higher premiums. the federal government will only subsidize based on silver. if you pick gold or platinum you will pay higher premium out of your own pocket. a also saw some brand co-pays in other sections if you search the site you will probably find them. also some plans have an rx deductible along with the co-pays.
Last edited by gerrym51 on Thu May 23, 2013 4:45 pm, edited 1 time in total.

BruDude
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Re: California affordable care act rates for 2014 released

Post by BruDude » Thu May 23, 2013 4:41 pm

magellan wrote:
BruDude wrote:....I was just saying it's interesting that three of the largest health insurance companies in the US have opted not to sell in the largest single health insurance market in the US.
I'm no expert on this, but some quick googling produced this LA Times article that shows that for 2011, Kaiser Permanente had 40% of the market in CA, followed by Anthem with 23%, 14% for Blue Shield, 9% for Health Net, and 5% for United Health.

Kaiser is a non-profit, so perhaps they're the Vanguard of health insurance in CA and they make the market less lucrative for outside for-profit firms.

Jim
Kaiser has a large market share in CA but in other areas they are not competitive. In the MD/DC/VA area their rates are significantly higher than every other company, especially on family plans. Blue Shield is also a non-profit and their rates in CA are higher than Anthem and other major carriers. Non-profit doesn't really mean anything in the health insurance industry.
Jack wrote:
BruDude wrote:I don't sell in CA but those rates are about double what the rates are for individuals in the states that I sell.
Given that CA rates on the individual market were roughly the same as the states I sell, the fact that these rates are about double is not meaningless.
I'm having difficulty parsing these statements. You seem to be saying the new California rates are twice as high as the rates in the states you sell. And also saying that previously the California rates were the same as the states you sell. Yet the current California rates are lower than they were before the exchange was established.
Where are you seeing that the 2014 rates are lower than the current rates?

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Re: California affordable care act rates for 2014 released

Post by Jack » Thu May 23, 2013 4:52 pm

BruDude wrote:Where are you seeing that the 2014 rates are lower than the current rates?
It is difficult to make a direct comparison of these rates to existing premiums in the commercial individual market because in 2014, there will be new standard benefit designs under the Affordable Care Act, and the actual change in an individual’s premium will depend on the person’s current insurance coverage. However, Covered California believes that a valuable frame of reference for its premiums, is comparing them to the small employer market in California. Both the small employer market and Covered California are competitive markets, and offer guaranteed issue – you cannot be denied for pre-existing condition.

The rates submitted to Covered California for the 2014 individual market ranged from two percent above to 29 percent below the 2013 average premium for small employer plans in California’s most populous regions.
Given that individual plans (for equivalent coverage) almost always cost more than group plans, this is a significant reduction.


I'm still trying to figure out your "double the rates" thing is about.

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Re: California affordable care act rates for 2014 released

Post by BruDude » Thu May 23, 2013 4:56 pm

Jack wrote:
BruDude wrote:Where are you seeing that the 2014 rates are lower than the current rates?
It is difficult to make a direct comparison of these rates to existing premiums in the commercial individual market because in 2014, there will be new standard benefit designs under the Affordable Care Act, and the actual change in an individual’s premium will depend on the person’s current insurance coverage. However, Covered California believes that a valuable frame of reference for its premiums, is comparing them to the small employer market in California. Both the small employer market and Covered California are competitive markets, and offer guaranteed issue – you cannot be denied for pre-existing condition.

The rates submitted to Covered California for the 2014 individual market ranged from two percent above to 29 percent below the 2013 average premium for small employer plans in California’s most populous regions.
Given that individual plans (for equivalent coverage) almost always cost more than group plans, this is a significant reduction.
Individual plans almost always cost less than group plans, not more. The average family plan I sell costs $300-600/month. The average family plan in group health insurance is around $1,200/month. You are comparing apples and oranges - I was referencing that the cost of these plans looks to be double the existing rates on the individual market, not double the rates on the group market. Guaranteed-issue coverage on the individual market forces the prices to level out with those paid for group health insurance since it is in effect transforming the individual market instead one giant group instead of allowing people in good health to get coverage at rates significantly below what they would pay for a group health policy.

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Re: California affordable care act rates for 2014 released

Post by Jack » Thu May 23, 2013 5:10 pm

BruDude wrote:
Jack wrote:
BruDude wrote:Where are you seeing that the 2014 rates are lower than the current rates?
It is difficult to make a direct comparison of these rates to existing premiums in the commercial individual market because in 2014, there will be new standard benefit designs under the Affordable Care Act, and the actual change in an individual’s premium will depend on the person’s current insurance coverage. However, Covered California believes that a valuable frame of reference for its premiums, is comparing them to the small employer market in California. Both the small employer market and Covered California are competitive markets, and offer guaranteed issue – you cannot be denied for pre-existing condition.

The rates submitted to Covered California for the 2014 individual market ranged from two percent above to 29 percent below the 2013 average premium for small employer plans in California’s most populous regions.
Given that individual plans (for equivalent coverage) almost always cost more than group plans, this is a significant reduction.
Individual plans almost always cost less than group plans, not more. The average family plan I sell costs $300-600/month. The average family plan in group health insurance is around $1,200/month. You are comparing apples and oranges - I was referencing that the cost of these plans looks to be double the existing rates on the individual market, not double the rates on the group market. Guaranteed-issue coverage on the individual market forces the prices to level out with those paid for group health insurance since it is in effect transforming the individual market instead one giant group instead of allowing people in good health to get coverage at rates significantly below what they would pay for a group health policy.
Okay, I get where you are coming from now. Note that I said "for equivalent coverage." It is you who are comparing apples to oranges. You are comparing cheap, crummy, low benefit, high deductible individual plans to the exchange plans. If you compare to an equivalent of the silver plan in the old individual market you would be paying a lot more. Anyone who has shopped for individual insurance knows that individual insurance costs a lot more than group insurance for the same quality of insurance. The fact that individual insurance in California is now cheaper than group insurance is a great accomplishment.

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Re: California affordable care act rates for 2014 released

Post by nonnie » Thu May 23, 2013 5:31 pm

BruDude wrote: Individual plans almost always cost less than group plans, not more. The average family plan I sell costs $300-600/month. The average family plan in group health insurance is around $1,200/month. You are comparing apples and oranges - I was referencing that the cost of these plans looks to be double the existing rates on the individual market, not double the rates on the group market. Guaranteed-issue coverage on the individual market forces the prices to level out with those paid for group health insurance since it is in effect transforming the individual market instead one giant group instead of allowing people in good health to get coverage at rates significantly below what they would pay for a group health policy.
The cheapest individual plan that Kaiser even sells in the several CA zip codes I checked for ONE 40 YEAR OLD MALE (Kaiser doesn't quote family policies online)-- again one 40 year old male is $162-that's the plan referenced below-- the highest is $512 per month. That's $6144 per year for one person. Most families in this age group I'm aware of who have group insurance and a cafeteria plan-- have family policies that cost them/their employer anywhere from $12,000 to $17,000 and up. I was allowed to stay on my ex-husbands plan until I reach retirement age and five years ago the cost for two-persons, PPO, was $10,200. It was a decent plan, not cadillac, and it was capped at $1 mil lifetime.

I'd suspect some of the carriers you mention who are not willing to compete in CA are doing so because in CA insurance is highly regulated.

Kaiser individual cheapest plan offered in CA
The Deductible 50/5000 with HSA plan has a $5,000 deductible. Most services are subject to the deductible. It can also be paired with an optional tax-advantaged health savings account. Many preventive care services, such as routine physical exams and mammogram screenings, are no charge. The deductible, copays, and coinsurance contribute to the out-of- pocket maximum. There is no prescription coverage.

Edit-- i scrwed up on the rates-- I put the highest monthly amount - $512 instead of the lowest $162 which relates to the details of the $5000 deductible plan.
Last edited by nonnie on Thu May 23, 2013 6:41 pm, edited 1 time in total.
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Re: California affordable care act rates for 2014 released

Post by BruDude » Thu May 23, 2013 5:52 pm

Jack wrote:Okay, I get where you are coming from now. Note that I said "for equivalent coverage." It is you who are comparing apples to oranges. You are comparing cheap, crummy, low benefit, high deductible individual plans to the exchange plans. If you compare to an equivalent of the silver plan in the old individual market you would be paying a lot more. Anyone who has shopped for individual insurance knows that individual insurance costs a lot more than group insurance for the same quality of insurance. The fact that individual insurance in California is now cheaper than group insurance is a great accomplishment.
Going to have to disagree with you. If you are healthy and under the age of 60, individual health insurance is going to be significantly less expensive than a comparable group health insurance policy in most states. I just ran a sample rate for a 40 year old in zip code 90001 and HealthNet's $4500 deductible HSA plan (100% covered after deductible) is $117/mo. Kaiser $2700 deduct HSA is $175/mo. The silver plan in Los Angeles has a $2,000 deductible, $6,400 OOP max, and costs $222/mo for HealthNet HMO or $252/mo for Anthem PPO. So you get to pay double the price, have a higher OOP max, and lose HSA compatibility.

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Re: California affordable care act rates for 2014 released

Post by BruDude » Thu May 23, 2013 5:53 pm

nonnie wrote:
BruDude wrote: Individual plans almost always cost less than group plans, not more. The average family plan I sell costs $300-600/month. The average family plan in group health insurance is around $1,200/month. You are comparing apples and oranges - I was referencing that the cost of these plans looks to be double the existing rates on the individual market, not double the rates on the group market. Guaranteed-issue coverage on the individual market forces the prices to level out with those paid for group health insurance since it is in effect transforming the individual market instead one giant group instead of allowing people in good health to get coverage at rates significantly below what they would pay for a group health policy.
The cheapest individual plan that Kaiser even sells in the several CA zip codes I checked for ONE 40 YEAR OLD MALE (Kaiser doesn't quote family policies online-- again one 40 year old male is $512. That's $6144 per year for one person. Most families in this age group I'm aware of who have group insurance and a cafeteria plan-- have family policies that cost them/their employer anywhere from $12,000 to $17,000 and up. I was allowed to stay on my ex-husbands plan until I reach retirement age and five years ago the cost for two-persons, PPO, was $10,200. It was a decent plan, not cadillac, and it was capped at $1 mil lifetime.

I'd suspect some of the carriers you mention who are not willing to compete in CA are doing so because in CA insurance is highly regulated.

Kaiser individual cheapest plan offered in CA
The Deductible 50/5000 with HSA plan has a $5,000 deductible. Most services are subject to the deductible. It can also be paired with an optional tax-advantaged health savings account. Many preventive care services, such as routine physical exams and mammogram screenings, are no charge. The deductible, copays, and coinsurance contribute to the out-of- pocket maximum. There is no prescription coverage.
I ran a sample quote in zip code 90001 for a 40 year old male and the cheapest plan from Kaiser was $143/mo for the $5k deductible HSA

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Re: California affordable care act rates for 2014 released

Post by neurosphere » Thu May 23, 2013 5:53 pm

Is there any way to guess/predict what the rates would be in other states? Can one assume that these could be good ballpark numbers? That is, I understand there could be a lot of variability from state to state, but is there any chance another state might have dramatically higher rates? As in double these?

I'm just trying to get an idea for worst-case scenarios for friends and family in other states who are eagerly awaiting some guidance an ACA rates for their specific situations.
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Re: California affordable care act rates for 2014 released

Post by Jack » Thu May 23, 2013 6:14 pm

nonnie wrote:The cheapest individual plan that Kaiser even sells in the several CA zip codes I checked for ONE 40 YEAR OLD MALE (Kaiser doesn't quote family policies online-- again one 40 year old male is $512.
Under the new exchange with Kaiser, in North LA, for example, a 40-year-old can get a bronze plan for $221 and a platinum plan for $388. Under the ACA, men and women pay the same rates.

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Re: California affordable care act rates for 2014 released

Post by nonnie » Thu May 23, 2013 6:45 pm

BruDude wrote:
I ran a sample quote in zip code 90001 for a 40 year old male and the cheapest plan from Kaiser was $143/mo for the $5k deductible HSA
There's an error in my post which I corrected above with an edit. My quote was for aip 94002 and instead of putting the lowest amount- $162/month for the Deductible 50/5000 plan which I referenced, I used the monthly amount for the highest plan @ $512 a month. Mea maxima culpa.

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Re: California affordable care act rates for 2014 released

Post by nisiprius » Thu May 23, 2013 6:48 pm

BruDude wrote:"Virtually every health plan designed a custom network for Covered California. Negotiations included a detailed review of each plan’s rates, their mix of hospitals, physicians and other providers, and their contingency plans for expanding networks in the event more consumers sign up than expected."

In other words, the networks for many companies will be local instead of national.
???? Maybe this varies from state to state, but I was covered by employer-provided HMOs from 1980 through 2010, from let me see, one, two, three different insurers, and never was I offered a national network. The network was always local; sometimes it included the whole state, sometimes it included part of the state and areas in adjacent states. The Blue Cross plans always made a big deal of saying their card was "recognized" nationwide; they all had something indicating some degree of coverage while traveling; and they all had some sort of appeals mechanism if there was a medically valid reason for going out of network. But the "network" was local--the provider directory was only about 3/8" thick. It was clear that you couldn't just go to the Mayo Clinic or Baylor University Medical Center just because you wanted to.

Do California employer-provided HMO plans customarily feature national networks?
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Re: California affordable care act rates for 2014 released

Post by gerrym51 » Thu May 23, 2013 6:51 pm

nisiprius wrote:
BruDude wrote:"Virtually every health plan designed a custom network for Covered California. Negotiations included a detailed review of each plan’s rates, their mix of hospitals, physicians and other providers, and their contingency plans for expanding networks in the event more consumers sign up than expected."

In other words, the networks for many companies will be local instead of national.
???? Maybe this varies from state to state, but I was covered by employer-provided HMOs from 1980 through 2010, from let me see, one, two, three different insurers, and never was I offered a national network. The network was always local; sometimes it included the whole state, sometimes it included part of the state and areas in adjacent states. The Blue Cross plans always made a big deal of saying their card was "recognized" nationwide; they all had something indicating some degree of coverage while traveling; and they all had some sort of appeals mechanism if there was a medically valid reason for going out of network. But the "network" was local--the provider directory was only about 3/8" thick. It was clear that you couldn't just go to the Mayo Clinic or Baylor University Medical Center just because you wanted to.

Do California employer-provided HMO plans customarily feature national networks?

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Re: California affordable care act rates for 2014 released

Post by BruDude » Thu May 23, 2013 7:07 pm

nisiprius wrote:
BruDude wrote:"Virtually every health plan designed a custom network for Covered California. Negotiations included a detailed review of each plan’s rates, their mix of hospitals, physicians and other providers, and their contingency plans for expanding networks in the event more consumers sign up than expected."

In other words, the networks for many companies will be local instead of national.
???? Maybe this varies from state to state, but I was covered by employer-provided HMOs from 1980 through 2010, from let me see, one, two, three different insurers, and never was I offered a national network. The network was always local; sometimes it included the whole state, sometimes it included part of the state and areas in adjacent states. The Blue Cross plans always made a big deal of saying their card was "recognized" nationwide; they all had something indicating some degree of coverage while traveling; and they all had some sort of appeals mechanism if there was a medically valid reason for going out of network. But the "network" was local--the provider directory was only about 3/8" thick. It was clear that you couldn't just go to the Mayo Clinic or Baylor University Medical Center just because you wanted to.

Do California employer-provided HMO plans customarily feature national networks?
That's my point...most of these listed on the CA exchange are local HMO plans instead of national PPO plans. Almost all of the plans I sell are national PPO network plans, usually Blue Cross/Blue Shield.

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Re: California affordable care act rates for 2014 released

Post by archbish99 » Thu May 23, 2013 7:21 pm

nisiprius wrote:
BruDude wrote:"Virtually every health plan designed a custom network for Covered California. Negotiations included a detailed review of each plan’s rates, their mix of hospitals, physicians and other providers, and their contingency plans for expanding networks in the event more consumers sign up than expected."

In other words, the networks for many companies will be local instead of national.
???? Maybe this varies from state to state, but I was covered by employer-provided HMOs from 1980 through 2010, from let me see, one, two, three different insurers, and never was I offered a national network. The network was always local; sometimes it included the whole state, sometimes it included part of the state and areas in adjacent states. The Blue Cross plans always made a big deal of saying their card was "recognized" nationwide; they all had something indicating some degree of coverage while traveling; and they all had some sort of appeals mechanism if there was a medically valid reason for going out of network. But the "network" was local--the provider directory was only about 3/8" thick. It was clear that you couldn't just go to the Mayo Clinic or Baylor University Medical Center just because you wanted to.

Do California employer-provided HMO plans customarily feature national networks?
Can't speak for CA, but my employer-provided insurance has a nation-wide network. The local company is Premera, but it's BCBS-affiliated. I can (and do) go to the website and find in-network facilities near my parents or in-laws if we get sick while travelling, my wife saw a specialist an hour or two away who was in-network, etc. Anywhere we go away from here doesn't necessarily know Premera, but they know BCBS and Premera treats them as in-network for billing purposes.

I haven't looked to see if Mayo is in-network.
Edit: According to Mayo's website, out-of-state BCBS card with the "PPO suitcase logo" are in-network. So yes, we could just go to the Mayo clinic because we wanted to. :wink: (Now, how their contract rate compares with other providers, I don't know.)
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Re: California affordable care act rates for 2014 released

Post by gerrym51 » Thu May 23, 2013 7:32 pm

i think this is getting overrought. the exchanges are for people who don't get insurance any other way. as far as non-exchange plans they have to cover the minimums under obamacare.

If you want to get a SUBSIDY you have to buy from the exchange. if a plan in the exchange in california does not cover a hospital in Minnesota-so what- you may prefer a plan that does but if you want a subsidy you need an exchange plan.

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Re: California affordable care act rates for 2014 released

Post by magellan » Thu May 23, 2013 7:42 pm

gerrym51 wrote:i think this is getting overrought. the exchanges are for people who don't get insurance any other way. as far as non-exchange plans they have to cover the minimums under obamacare.

If you want to get a SUBSIDY you have to buy from the exchange. if a plan in the exchange in california does not cover a hospital in Minnesota-so what- you may prefer a plan that does but if you want a subsidy you need an exchange plan.
I think the expectation is that for individuals, nearly all people will shop for their policies on the exchanges regardless of whether they're eligible for a subsidy. Time could prove me wrong of course, but I don't think there will be many (any?) individual policies available in a state that aren't listed on the exchange, so it'll just make sense to begin the comparison shopping there.

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Re: California affordable care act rates for 2014 released

Post by rnitz » Thu May 23, 2013 7:50 pm

Not impressed. I live in California, and their cheapest estimate for a silver plan for my situation (55 year old with two kids) was over triple the cost I'm currently paying ($250/mo.). Admittedly, I'm on a catastrophic-only, very high deductible type of plan and not a silver plan. But that's what I want (so it's apples-to-apples to me, as I don't want to pay for the added benefits). I'll be curious to see what their absolute cheapest plan will be so I can do a real comparison.

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Re: California affordable care act rates for 2014 released

Post by gerrym51 » Thu May 23, 2013 8:00 pm

they go out of their way to show 21and 40 years old. i buy from the exchange in massachusets-health connector-if someone between 60 and 65 wants to buy it will be consederably more expensive and a 40 year old is considered young on medical insurance-it]s the over 55's that get hit

i am 62 and pay 575 /month 2000 deductible/4000 out of pocket.

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Re: California affordable care act rates for 2014 released

Post by Jack » Thu May 23, 2013 9:01 pm

gerrym51 wrote:they go out of their way to show 21and 40 years old. i buy from the exchange in massachusets-health connector-if someone between 60 and 65 wants to buy it will be consederably more expensive and a 40 year old is considered young on medical insurance-it]s the over 55's that get hit

i am 62 and pay 575 /month 2000 deductible/4000 out of pocket.
The ACA limits the age rating bands to a ratio of 3:1. That is, a 64-year-old will pay no more than three times that of a 21-year-old. This is a compression of the typical 5:1 ratio currently in many states, meaning that young people will probably pay a little more and old people probably a little less.

Also required are equal rates for men and women. Extra premiums for tobacco users is permitted.

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Re: California affordable care act rates for 2014 released

Post by Die Hard » Thu May 23, 2013 9:42 pm

Put on your seat belts! It's gonna be a bumpy ride come 2014. Not only is healthcare gonna change, the employment landscape is also going to change because of the ACA.
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Re: California affordable care act rates for 2014 released

Post by frugaltype » Fri May 24, 2013 5:45 am

gerrym51 wrote:
frugaltype wrote:
gerrym51 wrote: i did see 25 dollar generic co-pays on the cheapest plans. i am in the rx business and i have never seen a 25 dollar generic drug co-pay that is high
Did you mean to say you had never seen a generic drug co-pay as high as $25? I fork out $200-$300 a month for the generic for Rythmol 325 mg twice a day.

thats not a co-pay thats a price- are you saying your insurance companies co-pay for this generic is 300 dollars. are you sure thats not the deductible. some insurance plans have a prescription deductible that has to be met before insurance actually starts.

i have never seen a generic co-pay more than 10 dollars that i recall. and i have filled thousands of generic rx.
I am not clear on the terminology. I am using co-pay as in the sense of I go to the doctor, they say $20 please. I have no deductible on my Plan D. I pay out of pocket about $300 a month for that one "covered" prescription alone.

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Re: California affordable care act rates for 2014 released

Post by SteveB3005 » Fri May 24, 2013 6:38 am

Quite impressed. Using the Covered California Calculator , the Silver Plan for a 57 yr old on 120k income pays $561, I currently pay $795 for a comparable. Bring it on!

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Re: California affordable care act rates for 2014 released

Post by magellan » Fri May 24, 2013 7:33 am

SteveB3005 wrote:Quite impressed. Using the Covered California Calculator , the Silver Plan for a 57 yr old on 120k income pays $561, I currently pay $795 for a comparable. Bring it on!
That calculator is one of the first online tools that shows the dramatic impact the subsidy can have on marginal tax rates.

Consider a 59 year old retired couple that has flexibility in how much taxable income they draw each year. If they keep their taxable income just under $62,100, they get a $700 credit each month. If their taxable income increases by just $100, they lose the entire $8400 a year tax credit.

In addition, all their income is sort of subject to a 9.5% surtax because of the loss of subsidy on that income. For example, if the early retirees reduce their income from $61k down to $50k, their subsidy increases from $707 a month to $802 a month. So it's as if their marginal tax rate is 9.5% higher on all income.

I know this is a backward way of looking at this. We are talking about a subsidy rather than a tax increase. However, in terms of the hard numbers the subsidies result in income up to the 400% FPL limit getting pretty highly taxed for early retirees, compared to managing their income so it stays low. So while these premium subsidies are a great deal for early retirees, they sure throw a wrinkle into early retirement tax and income planning.

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Re: California affordable care act rates for 2014 released

Post by gerrym51 » Fri May 24, 2013 8:28 am

frugaltype wrote:
gerrym51 wrote:
frugaltype wrote:
gerrym51 wrote: i did see 25 dollar generic co-pays on the cheapest plans. i am in the rx business and i have never seen a 25 dollar generic drug co-pay that is high
Did you mean to say you had never seen a generic drug co-pay as high as $25? I fork out $200-$300 a month for the generic for Rythmol 325 mg twice a day.

thats not a co-pay thats a price- are you saying your insurance companies co-pay for this generic is 300 dollars. are you sure thats not the deductible. some insurance plans have a prescription deductible that has to be met before insurance actually starts.

i have never seen a generic co-pay more than 10 dollars that i recall. and i have filled thousands of generic rx.
I am not clear on the terminology. I am using co-pay as in the sense of I go to the doctor, they say $20 please. I have no deductible on my Plan D. I pay out of pocket about $300 a month for that one "covered" prescription alone.

since we were talking insurance i did not realize that you were on medicare. Plan D plans do not work like regular insurance . are you in the donut hole

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Re: California affordable care act rates for 2014 released

Post by BolderBoy » Fri May 24, 2013 8:50 am

BruDude wrote:
magellan wrote:
BruDude wrote:Kaiser has a large market share in CA but in other areas they are not competitive. In the MD/DC/VA area their rates are significantly higher than every other company, especially on family plans.
Sure not true in the Boulder/Denver market. Kaiser is much cheaper than virtually all other carriers.

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