ACA 2016 premium observations

Doing something about malpractice costs and the resulting "defensive medicine" would help, too.

I know three doctors (well, two now because one has passed away) who gave up medicine altogether and pursued other lines of work, and one who gave up his private practice and took a position at the V.A., because their malpractice premiums were so high.

Rich
 
Weren't we told by "those that shall not be named" that once we started insuring all of the uninsured that the costs would come down? Seems to me $2,500 a year was the number being used by "those that shall not be named".
 
Doing something about malpractice costs and the resulting "defensive medicine" would help, too.

I know three doctors (well, two now because one has passed away) who gave up medicine altogether and pursued other lines of work, and one who gave up his private practice and took a position at the V.A., because their malpractice premiums were so high.

Rich

5% of the population accounts for over 50% of the health care expenditures in the US. Who is that? Folks over 65, the majority of that is 85+, years, and the money is spent largely in the last weeks of life. Until we stop thinking we can live forever, and/or stop sending Granny off to die in the most expensive way possible, we will never get a handle on this problem.

Of course, it is a moneymaker for doctors and hospitals...
 
Looks to me from a brief look, the rate hikes hit the gold, platinum plans the hardest.
 
Please no discussions of bicycles here!
 
In case anyone needs information:

HHS said that the average premium for closely watched types of silver plans was rising by 7.2 percent before subsidies were taken into account. The department also said 86 percent of current HealthCare.gov customers can find a plan with lower premiums, before subsidies, by shopping among available options.

"Consumers will continue to have affordable choices in 2016," said Richard Frank, HHS' assistant secretary for planning and evaluation. "While every market is different, and the reasons for rate changes vary, what's important for consumers to understand is that about 8 out of 10 returning consumers will be able to buy a plan with premiums less than $100 a month after tax credits; and about 7 out of 10 will have a plan available for less than $75 a month."


And the mechanism for increases above 10%...
Rate Review helps protect you from unreasonable rate increases. Insurance companies must now publicly justify any rate increase of 10% or more before raising your premium. This does not apply to grandfathered plans.


And the cap on insurance company profits:

The 80/20 Rule generally requires insurance companies to spend at least 80% of the money they take in on premiums on your health care and quality improvement activities instead of administrative, overhead, and marketing costs.

The 80/20 rule is sometimes known as Medical Loss Ratio, or MLR. If an insurance company uses 80 cents out of every premium dollar to pay for your medical claims and activities that improve the quality of care, the company has a Medical Loss Ratio of 80%.

Insurance companies selling to large groups (usually more than 50 employees) must spend at least 85% of premiums on care and quality improvement.

If your insurance company doesn’t meet these requirements, you’ll get a rebate from your premiums.

And geography matters....

Averages won't tell the story, because health care is local. Premiums can vary widely from state to state, and within a state.

Most states won't be like Minnesota, where all five carriers selling individual policies on the insurance exchange have posted double-digit increases, from 14 percent to 49 percent.

They're not likely to be like southern California either, where officials forecast an average rise of 1.8 percent for consumers who stay with their current plan.
 
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You need to also figure I your employer tax credit on premiums you pay.

Will change your math, dramatically.

Not for the example he gives. There are also about 12 hoops to jump through to qualify for the credit.

I had the accountant calculate the credit. He told me that even if we were eligible, it wouldn't amount to the fee he charges for filing the form. He was right.
 
If you look at the numbers, it is difficult not to conclude that the system was not engineered to fail.

I think this point is important, and coincides with the whispers among very connected folks in DC when the bill was under consideration. That will, of course, play into the agenda of those that wand government-single-payer, and those that want it to all be private.

Sure. Move to a European style system or else put in regs/incentives to bring costs down to more affordable levels in the first place. This looked at the problem as "not enough people have insurance" instead of "insurance/healthcare is too expensive." The latter is the real problem.

Yes, such is our political process.

In case anyone needs information:




And the mechanism for increases above 10%...



And the cap on insurance company profits:



And geography matters....

Of course, the insurance companies can withdraw from the market altogether (as some have) or can create new companies and partnerships that charge new rates. Not simple, but can be done.

From my perspective, I drop off cobra at then end of the year. The rates in the exchanges are 2 to 3 times higher than my COBRA (no company subsidy) rate for dramatically worse coverage from the plans on the exchange. There are 30% fewer plans available than in 2015. And only 5 that qualify for HSA. The difference will amount to additional thousands of dollars a year out of my pocket.

Dave's experience just points out how high the barriers are becoming to start and run a small business - the deck is stacked against small companies. In DC, for example, there is a new requirement to provide paid family leave for employees, a requirement that all employers provide transit benefits, and a push for higher minimum wage. The additional a overhead costs for providing and managing these benefits is far easier for large companies to handle. So while there are those that rail against large companies, many of those same people push for benefits that small employers find very costly to provide.

/off soapbox
 
In DC, for example, there is a new requirement to provide paid family leave for employees, a requirement that all employers provide transit benefits, and a push for higher minimum wage. The additional a overhead costs for providing and managing these benefits is far easier for large companies to handle. So while there are those that rail against large companies, many of those same people push for benefits that small employers find very costly to provide.

To the end of the year, I will cease to do business in the district.
 
Not for the example he gives. There are also about 12 hoops to jump through to qualify for the credit.

I had the accountant calculate the credit. He told me that even if we were eligible, it wouldn't amount to the fee he charges for filing the form. He was right.



Can you show his math?

I am under a much different impression, and if my accountant is wrong, I would like to know.


Sent from my iPhone using Tapatalk
 
Glad I am on my wife's coverage that she receives from her place of employment......
 
To the end of the year, I will cease to do business in the district.


Isn't DC the epicenter of the 12 most wealthy counties in the nation?

Seems like success is almost guaranteed.


Sent from my iPhone using Tapatalk
 
Isn't DC the epicenter of the 12 most wealthy counties in the nation?

Yeah, but why put up with the district if you can serve those customers in the counties themselves.
 
Glad I am on my wife's coverage that she receives from her place of employment......

If the great master plan succeeds, you are going to lose that pretty soon.
 
Glad I am on my wife's coverage that she receives from her place of employment......

Yes, that is very good to have. I'm glad that I have company-sponsored health insurance for my family. But even then, the plans (other than the high-deductible ones which are typically $0) have gone up significantly in cost to the user since the enactment of the ACA.
 
Suppose an employer says "I can't afford group insurance, but if you sign up for an ACA bronze plan I'll reimburse your for the post-subsidy cost".



Would that be legal?



Or could this hypothetical employer fund health savings accounts for his employees that would cover most of the costs of a typical ACA bronze plan?


In some States it would not be legal because they have overriding laws that require employers of a particular size (no matter if that employer is all within the one State or scattered employees across all 50 States) that the employer of such and such a size must provide group health coverage.

Not that this rule doesn't get broken all the time. A "national" boutique store with 5 employees per tiny storefront might meet the company size rules with a store in every State, for example. But they're not going to shop a group plan nationally.

They're going to slide the employees more money and try to make the 50 storefronts look on paper like separate businesses.

And in most cases the employees will get a better deal that way, anyway. Where they didn't used to, was in pre-existing conditions prior to employment.

OBAMACARE, OBAMACARE, OBAMACARE, for crying out loud. There is a problem but don't discuss who caused the problem because it might affect the sensibilities of the people who voted the problem causer into office? Screw that politically correct BS. It's OBAMACARE, it was purposely designed to put the pain off until OBAMA is out of office and it's a disaster. Who do you suppose those "subsidies" are funded by?



Meh.



There's no need to call it by name, and it was (after all) passed by congress, our elected representatives.



The point is, we can discuss its effects and leave the whys and wherefores for another venue.


It's called that name specifically to hide the fact that most of the people standing on stages right now asking to be the next President, voted for the thing.

Our current President didn't write it nor vote on it. But his name is on it for a reason. Social engineering.

There is an eight term Congresscritter asking for your vote for them for President who voted on it. And others.

It helps to pay attention and not fall for dumb tricks like naming it after the guy who'll be long gone before it fails miserably, while there will still be eight term critters who created the mess on TV making sure the dolts think Presidents create and sign legislation.

Isn't DC the epicenter of the 12 most wealthy counties in the nation?

Seems like success is almost guaranteed.


And the highest per capita murder rate in the entire country, along with the highest per capita number of law enforcement professionals.

Irony. Fun.

Yeah, but why put up with the district if you can serve those customers in the counties themselves.


Ding ding ding. Smart.

To the originality asked question, our company's rates have increased roughly 50% overall in two year's time with employees footing roughly 35% of that and the company absorbing 65%.

They just did open enrollment a few months early to catch the last year they can stay in the large company pool after which due to a change in the underwriters rules on company size, we drop back into a small company pool where our claims add up to higher premiums faster. With one employee dying of a very long term and expensive cancer battle two years ago, and barring any huge claims in 2016, we'll have one year of exorbitant rates before the effect of the old loss "falls off" at the underwriters.

We've been told to expect another 25% jump in personal costs next year. That after two years of 20%+ increases already.

The move of the open enrollment date will alleviate it somewhat by starting one more year of only high rates and not "outlandish" ones.
 
No one has mentioned that a whole lot of employees are now 29ers since full time was reclassified to 30 hours.
 
No one has mentioned that a whole lot of employees are now 29ers since full time was reclassified to 30 hours.

What I see is people getting clobbered with deductibles. Comparing the premium numbers over the years is meaningless without knowing the deductibles and out of pocket maximums.

Happened to me too. Used to have a pretty standard 80/20 plan without deductible. Now I have some gawdawful high deductible plan with a 7k oop maximum and a very thin provider network. And I work for the insurance company :mad2: .
 
Good try. The problem is everything is for profit -- the care, the drugs etc. Prices go up, premiums go up and profits go up, but the non-benefit ratio stays the same. And the consumer gets screwed.

And the medical benefit ratio does not affect how insurance companies really make their money -- returns on investments.

That, and shortly after enactment, CareFirst lobbied for and got approved the ability to include "development costs" in the medical loss ratio. I assume that includes the tens of millions it's spending on it's new ad campaign...
 
I have 70 employees and there is no way I can get below 50, so I am working through it the best I can. I pay $260 per month for each employee and they pay the rest, from $150-900 depending on coverage, family coverage is around $1200 per month. Our deductibles have risen every year as we have tried to keep the premiums affordable for the company and the employees. More regulations and costs on the doctors side is leading to massive consolidations. My GP has been in practice for 30+ years and recently sold out to a hospital group, they couldn't keep up with malpractice insurance and the costs of the new regulations. :dunno:
 
Just found out - my mother is going to lose her doctor. He has tried to implement electronic record keeping and says it doesn't work for him. Unfortunately, He-Who-Shall-Not-Be-Named decided that all doctors MUST use medical record keeping or face reduced medicare payouts. The doctor sent a very nice letter which laid out his options

1) Quit medicine - he likes helping people so this is out
2) Implement electronic records - he hates computers so this is out
3) drop all medicare patents - see #1, this is out
4) Charge medicare patients an additional 15% surcharge to cover what the government is taking out. Someone has to pay it.

She can't afford to pay the extra 15%, so she has to now find a new doctor that will take on other medicare patients. Too bad because I know she really likes her doctor and would have liked to have kept him.

Not sure what happens if she can't find a new one. Perhaps she has insurance but no doctor that will take it?
 
1) Quit medicine - he likes helping people so this is out
2) Implement electronic records - he hates computers so this is out
3) drop all medicare patents - see #1, this is out
4) Charge medicare patients an additional 15% surcharge to cover what the government is taking out. Someone has to pay it.

She can't afford to pay the extra 15%, so she has to now find a new doctor that will take on other medicare patients. Too bad because I know she really likes her doctor and would have liked to have kept him.

Not sure what happens if she can't find a new one. Perhaps she has insurance but no doctor that will take it?

He seems a biy overly dramatic over a 2% penalty on a share of his patients.

He can't charge the patient extra.
 
He seems a biy overly dramatic over a 2% penalty on a share of his patients.

He can't charge the patient extra.

He can't recover his costs?
 
Yes, Kevin.
I ran one employee on both and it was 335/mo for me to buy something the employee would purchase for 58/mo with their 'rebate'.
Dave

What about those of us who don't get a rebate? The quotes I get are FAR far more than $58, I can't even get a quote at $335.
 
I checked on the exchange I would most likely use and I think the premiums have gone up.

But I look at total premiums for the year plus the maximum out of pocket. That is, theoretically, the most you would need to pay in a bad situation.

So if premiums are $10,000/year and max out of pocket is $7,000 (ballpark for a single person), the most you could be out is $17,000. That sounds like a lot but better than $100,000, or $1,000,000, which I believe is what most people are "insuring" against.
 
What I see is people getting clobbered with deductibles. Comparing the premium numbers over the years is meaningless without knowing the deductibles and out of pocket maximums.

Happened to me too. Used to have a pretty standard 80/20 plan without deductible. Now I have some gawdawful high deductible plan with a 7k oop maximum and a very thin provider network. And I work for the insurance company :mad2: .

Yep, the deductibles I see are 10xs my annual medical expenses. Basically I get quotes for ~$400 mo with coverage that is worse than the Major Medical policy I used to pay $400 a year for. Then there is the co-pays which looks like it works out to near 50%.

Obamacare was just a scam to create IRS forced profit increase.
 
Just found out - my mother is going to lose her doctor. He has tried to implement electronic record keeping and says it doesn't work for him. Unfortunately, He-Who-Shall-Not-Be-Named decided that all doctors MUST use medical record keeping or face reduced medicare payouts. The doctor sent a very nice letter which laid out his options



1) Quit medicine - he likes helping people so this is out

2) Implement electronic records - he hates computers so this is out

3) drop all medicare patents - see #1, this is out

4) Charge medicare patients an additional 15% surcharge to cover what the government is taking out. Someone has to pay it.



She can't afford to pay the extra 15%, so she has to now find a new doctor that will take on other medicare patients. Too bad because I know she really likes her doctor and would have liked to have kept him.



Not sure what happens if she can't find a new one. Perhaps she has insurance but no doctor that will take it?


I don't think he's allowed to do #4. They catch him doing that, they'll not only not pay him for those patients, they'll bill for all services rendered back a number of months for them as a penalty, and likely require him to undergo an ongoing audit to receive any more money from the system.

Wife worked for a place that was 100% Medicare and watched a couple of competitors screw up their coding of patient care and run out of money to make payroll when the entire monthly Medicare payment is withheld a couple of months in a row. Two to three months of no income/cash flow will wipe out most businesses who are new to the Medicare games. Medicare does that all the time.
 
I have 70 employees and there is no way I can get below 50, so I am working through it the best I can. I pay $260 per month for each employee and they pay the rest, from $150-900 depending on coverage, family coverage is around $1200 per month. Our deductibles have risen every year as we have tried to keep the premiums affordable for the company and the employees. More regulations and costs on the doctors side is leading to massive consolidations. My GP has been in practice for 30+ years and recently sold out to a hospital group, they couldn't keep up with malpractice insurance and the costs of the new regulations. :dunno:

This illustrates one of the unfair aspects, too. As a small business with 70 employees, you can't negotiate as good of a rate as big companies. So, you and your employees are stuck paying more.

Of course, that defeats the whole idea in the first place.
 
Obamacare was just a scam to create IRS forced profit increase.

Right, its another way to increase taxes on lower incomes and penalize those who earn more income.

It is designed to deceive! The tax credit is designed to make those feel better about getting a deal on their premiums, while at the same time screws them over. All the tax credit/subsidies enable the insurance companies to increase premiums significantly. Montana was near +34% this year! But, those with the tax credit don't notice much! That is until you make too much! Once you recognize that at a certain income level (in many cases, that is near $63,700 for a married couple), if you make just $1 over the prescribed limit, then it can cost you over $8500 in lost tax credit, then you will be begging your employer to not give you a bonus, cut your hours, or whatever to keep you below that level, or give you a lot more to make up the difference.

Once you qualify for the tax credit at the lower end (above 130% of poverty level), then for each additional dollar you earn, the tax credit is reduced for an effective additional tax rate of 15 to 17% on top of your regular income tax. That is until you reach that income level designated as the 400% poverty level. Then, you are penalized for having the gall to earn too much beyond poverty!

The deception is working quite well, because I have seen no one talk about this effect. That is probably because very few will take the time and have the system calculate the credit at various ages and income levels to actually see the effect. Its up to each individual/family to discover where this penalty applies in their situation.
 
Just went on the exchange to get some quotes. It's magic. The same plan I can buy through e-healthinsurance for $341.01/employee is $685.27/employee when quoted through the state exchange. The rub is that I can only get the tax credit if I buy through the exchange. So if I pay 50% of the premium and in a best case scenario get 30% of that through the tax credit, we are still in the hole. Got to love government at work.

(that's the same insurance exchange that sunk $170mil into building their software which didn't work. The first years enrollments were done on paper forms mailed to the insurance companies. Later the exchange was audited by HHS and was found to have overbilled the feds 24.8mil. And nobody is going to jail for this.)
 
I have 70 employees and there is no way I can get below 50, so I am working through it the best I can. I pay $260 per month for each employee and they pay the rest, from $150-900 depending on coverage, family coverage is around $1200 per month. Our deductibles have risen every year as we have tried to keep the premiums affordable for the company and the employees. More regulations and costs on the doctors side is leading to massive consolidations. My GP has been in practice for 30+ years and recently sold out to a hospital group, they couldn't keep up with malpractice insurance and the costs of the new regulations. :dunno:

There are actually incentives in the ACA that drive consolidation, including the mandate to improve patient outcomes. Much easier to do when you control the hospital facilities AND the medical professionals. One hospital group near me won't give admitting privileges to doctors that don't already have privileges unless they "sell out" their practices to the hospital.
 
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