Obama Care

scrubbs · 10-09-2013, 10:13 AM

As I said in a prior post my son is glad to see what is happening with his insurance.
Lower cost with better benefits but he works for a small company that owns 5 charter schools. He did not have to hassle with an insurance company. The company he works for assigned an administrator to walk the employees through the process.
He also lives in a state that accepted the Federal Medicaid money and that has to impact the cost of insurance for everybody living there.
On the other hand. he does not have any pre-existing conditions with high costs like we have to deal with.
scrubbs

StephC · 10-09-2013, 10:42 AM

Quote:

Originally Posted by gr8ful

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.

my plan was originallly written in 1999. it is a good plan that can no longer be purchased directly or through group, regardless of enactment of ACA. There are NO plans offered which provide same coverage to I have now regardless of pricing. In fact, there are no platinum plans offered to 48 year woman in florida.

gr8ful · 10-09-2013, 12:46 PM

I'm sorry to hear your situation Steph. I looked at a Florida Blue Cross website and saw an individual platinum plan with an $800 deductible, 90% coverage and a $2500 yearly maximum out of pocket. On the bottom was the fine print, "Premium is based on age, gender, county, tobacco usage, etc.". I don't know what that means exactly. It doesn't sound as good as your current plan but hopefully you can find something that can work well enough. Perhaps more plans will be offered between now and 3/2014. Good luck. I hope the uncertainty ends quickly. No one with MG deserves that kind of stress.

StephC · 10-09-2013, 04:17 PM

It appears there 'is a provision in the "Patient Protection and Affordable Care Act" section 1251 entitled "preservation of right to maintain existing coverage" and which states "nothing in the act shall be construed to require that an individual terminate coverage under a group health plan or health insurance coverage in which such individual was enrolled on the date of enactment of this Act. " There is also reference made to grandfathered plans...which I think would be something I want to do...

I need to read more - the Act is about 1,000 pages - but am hopeful there may be something in the Act which provides protection for situations like mine. It seems to me there be some sort of protection in it but based on the letter from my insurance company they make it seem as if the Act is terminating the coverage.

I am hopeful there might be a way to reject the termination letter and instead claim my right to continue with my current policy. I will post more as I learn more.

StephC · 10-09-2013, 04:21 PM

Quote:

Originally Posted by gr8ful

I'm sorry to hear your situation Steph. I looked at a Florida Blue Cross website and saw an individual platinum plan with an $800 deductible, 90% coverage and a $2500 yearly maximum out of pocket. On the bottom was the fine print, "Premium is based on age, gender, county, tobacco usage, etc.". I don't know what that means exactly. It doesn't sound as good as your current plan but hopefully you can find something that can work well enough. Perhaps more plans will be offered between now and 3/2014. Good luck. I hope the uncertainty ends quickly. No one with MG deserves that kind of stress.

Did it provide any premiums for any group?

i figured my medical billings for last year, based on billings not payments by insurance company, since insurance only pays about 1/5 of the bill! if I didnt have insurance, I would have incurred about $600,000 worth of bills (IVIG billed at $35,000 per every three weeks is big majority of that)

4-eyes · 10-09-2013, 04:52 PM

Thank you for the research and the time, Steph. I think it will be invaluable to all of us with these expensive diseases. I am really getting worried about it all.

Hopeless · 10-09-2013, 07:58 PM

Hi Steph C,

I am grandfathered under my individual policy as long as I make NO change whatsoever. Any change of any kind terminates your grandfathered eligibility. A grandfathered policy is also NOT subject to the rules of ObamaCare. In other words, if you have a lifetime limit, it still exits under a grandfathered policy. Any of the mandatory provisions under the PPACA, like maternity coverge, etc. does NOT apply to grandfathered policies. A grandfathered policy must not be changed in any manner. If you had certain coverages under your grandfathered policy, you may not ADD nor Subtract any coverage, including items that are now mandatory coverage items of the PPACA. Grandfathered policies are not allowed to make any changes, even ones that are now required under the law. Grandfathered policies are EXEMPT from the new mandates of covered items. About the only thing that is allowed to change on a grandfathered policy is the cost for it.

gr8ful · 10-10-2013, 10:41 AM

Steph, I could not find any premium information for that Florida BlueCross plan because I would have to apply and I'm not a Florida resident.

Meanwhile, that letter you got from your insurance company seems like a booby-trap. If you signed up for a plan under ACA, you would lose your chance at keeping your grandfathered plan. It appears they forgot to mention that there was a grandfather provision in the ACA. Perfect, they send out a letter like that, make you afraid, prod you into making a decision in the midst of fear and they get out of having to cover you under the terms of your old policy.

I may be way, way over-thinking but it may be in the insurance company's financial interest to 'bump' people with good plans into the exchanges. I hope you have unlocked the secret to keeping coverage that works for you. I'll be happy for you if you can find security during this change.

gr8ful · 10-10-2013, 10:46 AM

I'll also comment that StephC's discovery of the grandfather provision of the ACA could be very, very helpful to a lot of people. As the information about that becomes clearer it probably deserves some type of 'sticky' status and not just on the MG forum.

ginnie · 10-10-2013, 11:18 AM

I live in florida and you are right, it is awful. I am on medicaid/medicare. Most doctors have stopped taking patients with this kind of insurance. ginnie

Similar Threads
Thread	Thread Starter	Forum	Replies	Last Post
Obama Team Engages Public on Health Care	lou_lou	Parkinson's Disease	2	12-31-2008 06:16 PM

Site Navigation

NeuroTalk Online Support Groups

Obama Care

NeuroTalk Forums