Scrubbs,

I've heard about it happening to two other people as well. Just because you choose to keep your current policy does not mean that current policy will be available any more. It's a scary time for those of us with health issues.

Because I am self insured, I have only been able to get coverage from my state's high risk pool since my mg dx a few years ago.

Two weeks ago, the High Risk Pool notified me the State is ending all coverage effective 12/31/2013 at midnight since the Affordable Care Act will take effect Jan. 1, 2014.

So most, but not all folks, may be able to keep their insurance...my circumstance takes me out of the 'most' group!

There are 14 states that refused to set up state exchanges...so folks in those states have to go on the federally administered plan. Many of those same 14 states also refused federal funds to expand Medicare in their states -- so that will leave many folks that fall below the minimum income level for a federal subsidy uninsured.

The ACA requires insured individual plans and small group plans to provide coverage for the 10 categories of "essential health benefits" - ambulatory patient service; emergency service; hospitalization; maternity and newborn care; mental health and substance abuse disorder services; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services. It appears individual and small group plans that do not cover those 10 essential health benefits are being canceled. It's not a matter of changing insurance companies or not being able to keep your insurance company.

Within those 10 categories, what is covered will vary by state. HHS declined to issue regulations establishing a national definition. Instead, each state had to select an existing health plan as a base for determining what constitutes an "essential health benefit" within those 10 categories.

There are 27 states with federally-facilitated state exchanges, and another 7 states with "partnership" exchanges that are run by the federal and state governments together. The exchanges (including those that are federally facilitated) are just a place for you to go to get individual insurance - they aren't insurance plans themselves. Costs will vary and depend on the state in which you live.

In addition to reviewing the costs carefully, be sure to review the networks associated with the exchange-based plans. In order to keep costs low enough to have their plans approved to be offered on the exchanges, many of the plans come with much narrower networks of doctors that could further limit one's choice of doctors.

Hopefully some of that info is helpful.

How in the world would anyone believe that the "Obama Care" insurance takeover would benefit you when the plan is over 7,000 pages long and you have to "pass it to know what's in it". The congress that passed this mess didn't even read it.

The purpose of this plan is to make everyone dependent on the government. There is no way millions of people could be added to insurance coverage with pre-existing conditions and not have someone pay for it, hence the premiums for insurance that people currently have skyrocketed. Somebody has to foot the bill.

Although I'm on Medicare with an insurance supplement, my husband has an individual policy with a $10,000 deductible and his premiums are going through the roof.

Southern Bell

Southern Bell - ?????

I too, am on Medicare with an insurance supplement.

I am under the age of 65.

Do you know how or if existing supplemental premiums will be affected?

Thanks in advance for any info.

My son is a teacher for a charter school in California. He will keep the same coverage at a lesser cost. California is one of the states that accepted the Medicaid expansion. He does not any pre-existing conditions but it seems to me that in the states that took the federal funding would have an impact those states in a positive way. The funding would pick up the some costs that would have to be included in determining the price companies in the exchange have to charge.

I am not sure how Medicare works, and maybe Southern bell can respond.
Did the state you live in accept the federal funding?
If not, is it possible that your husband’s premiums are going up to cover your Medicare costs because the extra dollars are not there and he is picking up the slack for you?

In the states that accepted the federal dollars, lower income families may have access to expensive treatments, like infusions that would be not available to them otherwise.

The funding is only for the first 5 years, and if it works out like it is supposed to the free market will drive down prices for everyone because of more insurance companies will be vying for dollars. I personally think this will happen.

scrubbs

So what is the real world latest story on Obamacare? I am very interested in what is happening around the country. This is a complicated mix of individual needs, business, politics, law and is scary, especially if you have an illness like MG.

There's a lot of 'news' out there on Obamacare but some of it is contradictory and sounds like political spin. It's hard to know what the truth is. I thought I'd ask a few questions and also share what I thought was supposed to be happening. I may not have it right but I tried to ask questions below that go to the heart of the matter.

So who's deciding what we can buy? Is it true the feds are not the ones deciding the available insurance policies or prices but rather the insurance companies? I know the feds can set limits for what a minimum policy covers but that's not what we are talking about if the discussion is about IVIG coverage or coverage of 'off label' meds. In that case it was supposed to be free market competition without the need for a 'group'. Is that really happening? Is there real competition in different states?

I understand Obamacare operates on a state by state basis. That's the same as pre-Obamacare. So are the good plans offered in different states really that different? That would seem very unfair but I thought it would be decided by insurance companies, not the feds.

There seems to be at least five different cases to consider:
a) free care plans for low income people
b) partially fed subsidized plans for 'lowish' income people
c) plans offered (and typically partially subsidized) by employers
d) individual plans purchased by 'full paying' individuals
e) medicare supplemental coverage

a) I thought free care plans would stay about the same as pre-Obamacare. I thought nothing would change under Obamacare.

b) I thought that 'lowish income' people who could previously not have afforded insurance (like those whose employers did not offer a plan or kept work hours below 24 hrs) could now apply for a fed subsidy and purchase a reasonable plan. In the past, this would have been impossible because there would not be an employer subsidy and as an individual, the insurance company would charge very high rates and exclude people because of pre-existing conditions etc. Since the notion of being in a group is eliminated by the exchanges, the person could get reasonable coverage for a reasonable rate, partially subsidized if incomes were 'lowish'. The exchanges were supposed to provide competition to keep rates low. Many young people fall into this category. This is a new Obamacare category.

c) If your employer offers a plan it is likely subsidized at least 50% by the employer and it is in the employer's best interest to offer decent plans. Working people whose employers offer subsidized group plans will probably get a low rate because the employer pays a substantial portion of the cost. This is supposed to be the same with or without Obamacare.

d) People who don't have access to an employer plan but can afford coverage can buy through the exchanges and get 'group rates' as individuals. The exchanges would eliminate the need for a group and competition would keep rates low. I thought competition and the elimination of groups would make it easier for this category to get good plans at a lower rate. In this case, Obamacare was supposed to make it so individuals could get good rates despite not being part of a group.

e) I don't really know about supplemental plans. I have relatives who are very afraid right now. I thought these plans would be similar before and after Obamacare. In both cases they are purchased by individuals and I would think the free market would set pricing and coverage.

I know I've probably way over-simplified but that's the limit of my understanding. I personally fall in category C and I haven't seen a change except even employer based coverage seems to change from year to year. I've had to switch plans several times even with the same employer. My employer covers about 50% of my health insurance cost and to keep costs down, the plan has become leaner and leaner as time passes. My MG coverage has been good but I don't know what will happen down the road and that is a concern.

If I was an insurance company I would be very scared right now. I doubt I would offer my best deal to anyone because there is a lot of uncertainty. Obamacare hopes that hoards of young uninsured people will flock to purchase insurance and provide a larger 'pool' for everyone, but no one knows if that will happen. Supposedly, if that happens, we will all benefit but I doubt the insurance companies are willing to bet their profitability on anything right now. Wall Street doesn't reward CEOs that make bad bets and I think insurance company CEOs are not willing to make bets that can get them fired.

Because I have an employer based plan, I have a (perhaps misguided) sense of security right now but I do know what it's like to be scared of the uncertainty of MG and my heart goes out to those who now have to face the double uncertainty of Obamacare on top of MG. I'm very interested to hear what is happening to people in different states and in different situations because it could affect all of us. We don't have a lot of health insurance security in this country and a lost job or other misfortune can cause anyone to be in the shoes of another.

I hope I didn't step in some political pothole by writing this. I'm OK hearing people's opinions and it would be nice to also get some facts on the table. We've all heard a lot about what Obamacare will be and now is when we find out what it is. I hope whatever happens works out for all of us. We deserve good care.

Dear gr8ful,

I would love to respond to your post but I am afraid it may sound political no matter how hard I attempt to keep it out.

What I can say is that my primary care physician left his practice. I have paid for my own health insurance coverage, an individual policy for 40 years. I am NOT eligible for any subsidy unless I drop my insurance and go into an exchange. The cheapest exchange plan will only cover 60% of my incurred expenses. I would be responsible for 40% of everything. One short hospital stay could wipe me out completely and then some. I do not know what deductible would be involved. I would lose my drug benefit which would cost me over $1200 per month. No matter how high my current insurance will continue to climb, it will still be better than the alternative.

I have tried to state JUST my personal situation, NOT any "opinion" to avoid any issues to have my post removed.

You mentioned a lot of "suppose to's". Well, I am not sure things are turning out like they are "suppose" to. Good luck to everyone here with health care needs. Dealing with our illnesses is hard enough. I have several doctors and am thankful for them. I just hope I will not see any more loss of my docs.

the letter was sent by current insurance company and states
"The ACA will affect you health insurance plan. Your current policy will end on 3/31/2014. Therefore you will need to buy a new plan..."

It does state I can purchase an ACA plan from any insurer in the market, or on your state's Health Insurance Exchange.

my issue is not where I have to buy a plan but rather that the ACA is taking my plan from me! A plan I purchased in 1999 and for which I have always timely paid $1200 per month premiums for many years now which provided coverage at least covering the essential stuff then some...no annual deductible. A plan the coverage of which no longer is option for me at all.

PS the letter does say "We're here to help...call member services" which quite frankly is quite a joke as member services are the most incompetent, dismissive, condescending and unhelpful representatives I have ever dealt with!

Hopeless,
Are you saying there are no plans on the exchange that will cover more than 60% of your medical expenses? I believe you but why is that? If you are paying the full cost of your insurance and everything has been OK for years then what caused the situation to change? I thought you should be able to go on the exchange and buy a similar plan. You said the cheapest exchange plan will only cover 60%, what about the most expensive plan on the exchange? Aren't you able to buy a good plan through the exchange? Supposedly the exchanges are administered by the feds but the plans are whatever the insurance companies choose to offer. Your insurance company has been offered your plan for 40 years. Why aren't they offering the same plan on the exchange?

StephC,
I guess I have the same question. Are you able to get a similar plan on the exchange for a similar monthly cost? The exchanges are supposed to be a place where your insurance company offers various plans. The government doesn't offer plans, your insurance company does. Why wouldn't you be able to get a good plan at a cost similar to what you are paying now? Why wouldn't you be able to get the same plan you have now through the exchange?

The exchanges are supposed to just be a place where individuals can go as individuals and be treated as if they were part of a group. They would be offered the same plans as a group and pay the same cost as group member. It doesn't make sense that someone who is willing to pay the full cost of a comprehensive plan wouldn't be able to find a good plan on the exchange. Could it be that your current insurance company sells your current plan if you buy it through the exchange? Maybe you have to switch companies but there is a similar plan through the exchange?

I hope everyone finds a plan that works for their needs. It doesn't bode well for anyone if the insurance companies start denying coverage for things they've covered in the past.