Do the premiums change?
It all depends on a lot of factors - my particular plan is being discontinued so I had to choose another plan. The premiums are based upon your income level. Mine is probably going to be about the same. But it's so hard to tell how all this is going to be played out with congress fighting back and forth etc... it is very unsettling for the rest of us.
My mind is totally boggled at the idea of a $12,000 deductible! Since very few of us have anywhere near that much in medical expenses a year, that would mean we would have to pay everything out of pocket. That's like not having insurance at all!
I'm still trying to work out the details on medical *devices* but I think the ACA minimum requirements are absolutely clear with regard to treating things "totally separately"; as of Jan 1 it is no longer allowed. Everything gets added together with regard to the out-of-packet maximum; so if you go for a plan which has 80% copays (I think that's a 'silver' plan) when your deductible payments plus *all* your copays add up to the OOP maximum the plan pays 100%, for everything. It doesn't matter what you are paying for - 'supply', 'device', physician care, etc; it all gets added together.
John Bowler
My wife (non diabetic) has a $10,000 deductible. We pay for everything except certain covered preventative things (mammograms, flue shots and the like).
It *is* insurance - we're ensuring ourselves against having to pay more than around $30,000 in a year for her health care.
If you look at any *current* (pre-ACA) US health insurance plan you will find that if you get a serious problem you pay at least $20,000. If you can't come up with that money you end up being sued by your health providers (and probably going bankrupt). One of the things ACA changes is to lower this limit, but it's still around $10,000.
John Bowler
I would imagine they could like any other insurance plan. And subsidy amounts, if you qualify, would probably change with income and cost. Subsidies are based on the cost of a lower silver level plan. The subsidy amount doesn't change if you opt for a higher or lower level of coverage, but your portion would.
Consumer Reports has a free ACA guide you can download
I.e. you get a fixed subsidy based on your (family) income and you can spend it any way you want.
John Bowler
Alas that guide is not very helpful at all so far as this discussion is concerned.
It doesn't even address the issue of people who regularly meet their deductible under existing insurance plans; this is typically true of PWD. It certainly doesn't discuss the issue of the treatment of pump supplies ;-)
I think it's necessary to consider where we are now before working out where the ACA takes us. At present selecting an insurance policy for a diabetic is pretty simple - you don't; either your employer gives you one (no choice) or you use one provided by the state (no choice) or possibly a high-risk insurer (incredibly expensive.) The complexity only comes when the insurance provider who you didn't chose starts making you pay money and that is *really* complex.
The change in 2014 is that we have a choice, which makes things much more complex for PWD, but the complexity of the policies we have to chose from is vastly reduced.
The opportunity for insurers to move supplies from one payment class to another to maximize the money we pay *should* be eliminated, but ultimately the lower out of pocket maxima might start to be met by PWD and then insurers will stop gaming the system, at least for diabetics.
John Bowler
Sadly, that Consumer Reports piece doesn’t provide much information at all. It reads as a propaganda piece to me.
I am looking for real details, and they are lacking everywhere I look.
Unfortunately, I can’t point you to an URL. However, the device manufacturers are well versed in the effect as they are being taxed an additional amount to pay for ACA. I suggest calling any one of them for details on what you are asking about.
Sorry that we’re type 1 diabetics and we’re being forced to pay extra for ACS, but hey, that’s the reality.
I'm self -employed so I have had to get insurance for my 12yo son (type1) and myself. My husband is military disabled so he is seen thru the VA. (a blessing) My sons insurance was 95.00 a month. His plan has to change because it is no longer being offered. They are switching him to silver plan. His premiums are going up 61%. to 155.00 per month. But at least he has maternity coverage.(oh yeah).I have my insurance thru a different carrier and don't know yet how high the premiums will go. We will not qualify for any subsidy. I just hope that there will be enough doctors to go around. we will be adding millions new patients and not adding any doctors. I have a feeling January 2nd will be a busy day for the doctors.
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From the ADA. http://m.diabetes.org/living-with-diabetes/treatment-and-care/health-insurance-options/health-insurance-marketplace.html The most important piece for me is that no one can ever deny my daughter coverage because she has diabetes. Not these exchange plans, or any other insurer plan. And she can stay on our family plan until she’s 26. I’ve looked and found there are levels for the plans. You choose how to go, and each state will be different. Premiums will vary according to age, like they do now, but they cannot charge more bc a person has diabetes, or any other condition like they did in the past. Awesome. My guess is that the systems are boggy right now because millions of people are trying to access them.
I’m on medicare advantage, in June I was informed that part of my pump supplies where no longer covered. In July I was informed that my doctor was closing his practice effective December 2013, I need to find another doctor. Last month my in home nurse who does catheter changes ever two weeks dropped me.
I sympathize. Obamacare will help some people. But it will also cause problems for a lot of people that already had insurance, and it isn't necessarily true that if you like your plan, you can keep it. I know a family that is going to have to pay $500 more per month because of the way the law has affected group insurance. The husband was dropped from his wife's group plan, but the kids can still be covered. Their premiums are going up and benefits are going down. He has to get single plan insurance through his employer now. Their out-of-pocket is likely going up too. Adding $500+ to a family's medical expenses is not "affordable". :/
Wow there is so much misinformation out there.
I suggest everyone go to the website and see what the options are. I saw nothing with a deductible for as high as $12,000. I cant imagine where that came from
I live in California. Right now I have MRMIP insurance it is a california state regulated policy that I pay $490 a month for, A comparable plan in ACA is about $ 500 but the specifics around what it covers and how much is unclear.
Mu MRMIP plan has a lifetime cap though. The ACA plans wont have a cap.
Really these are just insurance polices put up by insurers, The government is only changing rules about how the insurance companies accept or deny patients.
The government subsidies are through tax credits. So in reality the government is not involved in the actual policies.
Indeed; Medicare and Medicaid are very different things from insurance.
One of my worries is that I might mess up my income (I've been effectively retired since 2001) and end up on Medicaid. Sure I don't want to pay taxes, but I don't want my AGI to drop below the point where I can't get insurance on the exchanges!
So far as I can see there's no solution at present for people over 65 - are there any insurance companies out there who will cover people above that age?
John Bowler
The $12,000 deductible was for an *existing* health plan. It was for MarysMom and her husband, who are *not* diabetics. The plan the navigator suggested for 2014 reduced the deductible to $200, provided prescription coverage and, maybe, reduced the premium.
Those plans are going. The plans I've seen that match ACA requirements have deductibles *and* out-of-pocket maxima around $6000; basically the plans pay 100% of costs one you've paid $6000 in copay+deductible.
John Bowler
There is a very real question of exactly how pump supplies get treated; in my case that means Omnipods ($25 each, street price, one every three days) and is a significant cost.
However there's another twist in the ACA that probably effects almost every diabetic; so far as I can see plans are offered on a *family* basis, where 'family' means everyone who appears on the same tax return.
This seems to be very important because, while the *premium* is the sum of the individuals premiums the deductible and out-of-pocket maximum don't seem to change. For example if I just list myself on coveroregon.com the lowest premium is $294/month with a deductible of $5,250 and an OOPmax of $6,350. If I add my wife I get a premium of $485 but the other figures do not change.
This is very important for diabetics because in general we meet the deductibles and can come close to the oopmax; the point at which the plan pays 100% of additional health care costs.
For those of us who will hit the oopmax the whole issue of copays and deductibles becomes moot; who cares what the money is called! For family groups having an oopmax that does not increase is an enormous benefit (assuming I'm reading coveroregon.com right) but is entirely reasonable because it is the family income that determines how much we can pay, not how many of us get sick.
John Bowler
Wow there is much disinformation out there! The government is significantly changing Medicare, and what Medicare covers, and does not cover. To claim that the “only” changes are about the rules for who companies accept or deny, is very simply false! It doesn’t take thousands of pages to accomplish that. Yes some people will get extra help, but others will feel extra pain!
Kevin, you are correct.