Sophiafthrace,
You, as Kevin (above), are also correct.
Actually all lifetime caps have been removed from insurance. ACA or not. Thanks for your comment I just anted to correct one thing. Thanks for the good information.
Thanks john for the for informative response. Of course each plan is different and each offered plan needs researched before singing up. I believe the companies generally are available to answer specific questions? I am not signing up since i have existing coverage and am satisfied with the payment and coverage.
Still I am a very big supporter of the ACA since it supplies options largely for people who do not have and cannot get life insurance. It is a great opportunity.
Interesting story here, http://www.bloomberg.com/news/2013-10-04/is-obamacare-s-first-enrollee-bogus-.html
http://online.wsj.com/article/SB10001424052970203370604577261340363566590.html
Yes, the companies can be asked directly. Also, as other people have commented, there are ACA navigators who will help. The important thing for PWD is to work out the questions though! We're different because we have a chronic illness and we have known medical costs.
When the Oregon exchange goes live for open enrollment (enrollment is only through navigators at present) I'll have a market cost price for a years supply of insulin, test strips and Omnipods then I'll be able to get very precise figures for the total cost (including premiums) of each option.
It would be really good if the ACA forces all the insurers to treat Omnipods the same with regard to the deductible and copay in the plan (preferably as supplies - like the Medicare treatment), then the calculation is a ridiculously simple piece of math.
John Bowler
The government IS involved in actual policies because the law doesn't just discuss acceptance of patients, it has minimum guidelines that the insurance policies have to meet. Many people's policies are being cancelled because their policies didn't meet the new guidelines.
Life insurance? or did you mean health insurance?
Your comment adds zero value to this discussion.
One link leads to a stale March 14, 2012 Wall Street Journal opinion piece that's hidden behind a paywall. The other focuses on inevitable glitches that will plague any large government plan rollout offered to a market with huge pent up demand.
Not interesting at all.
I'd love to be able to get life insurance...
Supposedly, ACA was not supposed to affect those on medicare. Unfortunately, anything that affects the ability of doctors or other medical providers to practice will impact you. As for having to use exchanges and get an ACA approved plan you shouldn't have to do that.
I used to do HR and have been to several seminars on ACA. From what I understood, medicare wouldn't be affected by ACA. You still are supposed to have the same plans etc that you always could have. The law is only supposed to change things for those not on medicare.
My quick summary on what I know about ACA. I attended some seminars on ACA a few months ago. Things change and much of the info came from Blue Cross and some from the department of insurance in North Dakota. Basically, what I was told that medicare stuff wouldn't change and there were no laws changing anything to do with the policies pertaining to medicare.
Medicaid in many states will increase the number of people eligible.
No one seems to know how military insurance is going to change. My daughter says she hasn't gotten anything from her insurance company yet to tell her if there are changes. Since it is a government plan I don't know if it is exempt in some way.
ACA sets requirements for what is covered ie. mamograms and certain other preventive services. Individual insurance companies then put together a plan. It appears they can make a plan slightly better or worse (each metalic level has a range of acceptible stuff). Each tier has to cover a certain percentage. From what BCBS was saying it looks like all companies will be offering the same thing since offering a little more and charging a little more might not go over as well as being the lowest cost provider.
The insurance agent you use now may not be able to help you anymore but it never hurts to ask. There were some questions about how the navigator laws would affect agents.
If your employer continues to offer insurance then you aren't eligible for subsidies so you are likely better off taking your employer plan.
Some smaller employers are eligible for subsidies and may be able to offer you insurance for a better price because of that.
Navigators should be able to help you understand what is going on and help you pick a plan. Remember they are having to learn too.
ACA has caused the higher deductible, catastrophic type plans to be cancelled and if you have one of those it may cost you more in premiums but it will likely cover more than your old plan.
Each state may have different rates so what is happening to one person may not happen to another The only real way to know is to check the exchange, talk to your employer, talk to an agent or navigator.
Right now, they are working bugs out of a lot of newly brought up systems and navigators and agents are having to learn a lot of new stuff. These policies aren't supposed to take affect until 1/1/14 so you have a little breathing room. Don't stress too much over it yet.
Some employer plans fall under the grandfather clause and you may not see changes if your employer's group policy is one of those. Eventually, it is likely that something will happen to ungrandfather the plan and then the ACA laws will affect your plan.
As with any sweeping change, there is good and bad and there will likely be changes happening as everyone figures out what all this means. Sadly, that often leaves us normal people with a lot of questions.
I think this link is helpful. It's specific to the design of the NY exchange, however it illustrates how the various numbers interact. It's from May 2013:
http://www.dfs.ny.gov/insurance/health/std-exch-bdesign.pdf
WARNING: I got this through Google, it's information for insurers, this page:
http://www.dfs.ny.gov/insurance/ihealth.htm
contains a link to the PDF, but I *don't* know how up to date it is.
So far as the current discussion is concerned, with all the caveats I listed above, the 'medical supplies' treatment is on page 2 near the top "DME/Medical Supplies", page 4, at the end, gives the treatment of 'prescription drugs'.
Consequently, at least so far as NY is concerned, it looks like insulin will be a flat copay, even for GM insulins where today insurance policies charge a % copay.
Meanwhile Omnipods and blood test strips would, presumably, be 'medical supplies'.
Perhaps the most important entry so far as the original question is concerned is that near the top of page 4 which discusses "Durable medical equipment and medical
supplies" and states "DME/Medical supplies coinsurance cost sharing applies." So pumps and pump supplies are treated the same way.
This is pretty clear, and apparently levels the playing field for the various insurance companies.
As I understand it for those of us with income more than 2x the federal poverty level (FPL - about $23k for a family of four) we are looking at $70 for a month supply of insulin, or twice that (two insulins) for those of us using MDI. My understanding is that there is no deductible here - it's just a fixed cost for each prescription until the out-of-pocket max is hit.
Blood test strips will be supplies with a % copay, since the retail price of strips varies so much there is a lot of choice here - I've seen prices between $20/50 and $70/50. I guess ACA will result in competition here and this is what has got the expensive test strip vendors so worried (see the recent politicking on tudiabetes.)
For pump users we need medical supplies at 20% (gold) or 30% (silver) copay. Conceivably some diabetics may be better of on Bronze schemes, but the copays go up a lot (50%). It is necessary to meet the deductible before the plans pay anything. The NY deductibles are $600 (gold) or $2000 (silver). [Oregon, however, apparently allows insurers to set the deductibles and oop-max within the federal limits.]
Deductibles and oop-max for a family are twice that for an individual - I got that wrong before, but the NY document states it explicitly. The largest oop-max permitted is $6350 dollars/$12700 for a family. My guess is that Type 1 diabetics will want to enroll as individuals!
For me this breaks down:
Insulin (Humalog, 5x3ml pens/month): $250, silver copay $70
Test strips, about 300/month, assuming $1 each: $300, silver copay $90
Omnipods (10/month): $250, silver copay $75
So if I lived in NY I would be looking at a basic copay of $235/month once my deductible is met. A silver deductible is $2000, and test strips and Omnipods count against that; so I pay full price for about 4 months. Total (per year) cost is:
Test strips: $300 x 12 retail: $3600
Omnipods: $250 x 12 retail: $3000
------------------------------------
$6600
$2000 deductible + 30% gives: $3380
Insulin: $70 x 12 = $840
------------------------------------
Total out-of-pocket: $4220
On the NY silver plan the maximum OOP is $5500, so all I need $1280 of additional expenses to hit the OOP max. Most of the time this wouldn't happen, but any significant illness would throw me over the max. This is why I've been emphasizing the ACA changes to the OOP max so much.
Because we're all likely to see figures like this it will take some time, and the specific numbers, for each of us to work out what sort of plan we need. The premium savings I seen for a Bronze plan vs Silver (around $250/month less; $3000/year) are enough to make up for the raise in OOP max ($850 in NY) and, in my calculation above, are enough to make up for the amount I'm short of the OOP max on a silver plan! Apparently I might save $1000/year by going for a Bronze plan and having much bigger copays.
These calculations are the kind of thing ACA navigators should be able to do in their sleep, but they do need to know the amount each of us spend on diabetic stuff every year so we each have some prep work to do before consulting a navigator.
John Bowler
This post is nasty, and uncalled for. "what motivates you to put out incorrect info"... geez. Perhaps because he innocently had incorrect info?
This all goes to hell when people start questioning and disparaging other's motives, without a scintilla of evidence about someone they know nothing about to base those speculations on.
Frankly, I'd be a bit pissed off to have someone respond to a completely innocent sharing of what I'd found out about to then be told, "You are attempting to mislead people into thinking this is a bad thing". You don't know that!
All this post did, and several of your other posts in this thread, was to make it clear that YOU are the political partisan with an agenda bashing others here to keep them quiet.
Please take that crap to a political debate site.
When you look at the available plans, are you looking at plans from the high-risk pools that are supposed to be available? I would imagine that those plans are the ones that are going to provide the most comprehensive coverage.
Please keep in mind that the plans available are likely to vary from state to state. What is true in YOUR state may not be true in mine. The states that moved quickly to set up the infrastructure to make the law operational are seeing better results in terms of availability of low-cost coverage than states like mine that have a recalcitrant governor and/or legislature and are thus slow to act. So what you're calling "incorrect" may, in fact, be accurate for that poster's state, if not for yours.
Thanks, HPN; I'm in the process of finding out how my CalPers and Medicare get integrated; I didn't think the ACA would affect it, but wondered.
In my experience, high risk pools are a last resort for people that couldn't get insurance because of a pre-existing condition. They are very, very expensive and can have high deductibles and insufficient coverage. I would think high risk pools would become obsolete now with the laws to protect people with pre-existing conditions.
ACA and Medicaid (not Medicare) are intimately linked; people who have income below the federal poverty level will not be permitted to buy insurance on the exchanges and will be eligible for Medicaid.
Any statements that might be made here about coverage under an insurance plan that meets the minimum ACA requirements does not apply at all to Medicaid.
Coverage on Medicare is yet another thing, as you say it's not related to the PPACA, however it's changing because of the federal budget issues - it takes a lot of money.
At this point Medicare isn't tied in to the equation, but the Bush government was pushing for privatization very much along the lines of the ACA. I imagine that if the ACA is a success that push will return, at least from the party that pushed for it originally.
John Bowler
You should raise the pump supplies issue in one of the pump groups on tudiabetes. I know that for Omnipod there have been discussions between podders using Medicare about how to get Medicare to pay for pods - which are, I believe, classed as pump supplies by Medicare.
It sounded like going directly to the Medicare administration might help, but I'm not up-to-date with Medicare; I'm 53, so I have ten, probably fifteen, years to go with insurance.
John Bowler