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View Diary: A really interesting thing I found out today about health care insurance, that no one's reporting on (98 comments)

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  •  Well, what about people who don't have (1+ / 0-)
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    Well, what about people who don't have behavioral health issues?  Should they pay for those who do?
    Sure.  That's why I didn't include that in my statement.  I specifically pointed out what certain-aged people will never need, but behavioral health issues can apply to everyone.
    "Jump in the pool together."
    But not everyone is going in the pool.  In fact, two million people already have received letters that said they can't continue their current policy because it' s no longer offered.  So not only do we have a mandate to buy insurance, we apparently have a mandate to buy insurance that we know we will never need.  And like I said, I didn't know that before.
    •  here's the thing: the exchange policies are (4+ / 0-)

      defined in terms of benefits across the board.
      The companies' versions, outside the exchange, are not.
      Because of this loophole the companies outside can and do weasel on the coverages and premiums.

      LBJ, Van Cliburn, Ike, Wendy Davis, Lady Bird, Ann Richards, Barbara Jordan, Molly Ivins, Sully Sullenburger, Drew Brees: Texas is NO Bush League!

      by BlackSheep1 on Tue Oct 29, 2013 at 11:23:57 AM PDT

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      •  That's exactly what I wanted to know. Thanks. (1+ / 0-)
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        But what I don't understand is inside vs. exchange the exchange.  But do the outside companies also have to abide by those ten things written in the law, or only those who participate in the exchange?

        I quoted the ten things in the link below.  Do these apply to only those companies who join the exchange or does it apply to every policy whether inside or outside the exchange?  Thanks.

        •  I think it is limited to offerings in ("on") the (3+ / 0-)
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          gooderservice, Lily O Lady, JerryNA

          exchange -- the policies available there, if I understand this correctly, must cover all 10 of those things.

          To get the same coverage, even from the same insurer, outside the exchange is to be at a different level in the risk pool, and therefore subject to different (read usually higher) costs.

          The risk pool in the exchange, as I understand it, is sort of one-size-fits-all in order to make the biggest group of policy buyers fit into the category.

          LBJ, Van Cliburn, Ike, Wendy Davis, Lady Bird, Ann Richards, Barbara Jordan, Molly Ivins, Sully Sullenburger, Drew Brees: Texas is NO Bush League!

          by BlackSheep1 on Tue Oct 29, 2013 at 11:53:58 AM PDT

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          •  so why would you ever.. (1+ / 0-)
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            go outside of the exchange?

            I suppose if there's a plan outside of the exchange that provides better coverage that just isn't offered inside the exchange?

            But so far, that doesn't seem to be the case for the things that are important to me (the only difference for the plan I chose seemed to be pediatric dental care, and at 100/month, doesn't seem worth it even if I needed that).

            •  Exactly. And the advice given to you in many (0+ / 0-)

              comments here is right:  Stay in the exchange.

            •  The principal reason is differences in network (1+ / 0-)
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              Exchange plans are cheaper, in part, because they have restricted provider networks, even if (compared to non-exchange plans) they have the same co-pays, deductible,s and maximum out-of-pocket amounts.

              So check to see if your preferred provider is in the exchange plan you are considering.

              "Well, I'm sure I'd feel much worse if I weren't under such heavy sedation..."--David St. Hubbins

              by Old Left Good Left on Tue Oct 29, 2013 at 03:05:30 PM PDT

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              •  That's a worthwhile consideration. (0+ / 0-)

                I know the provider network's narrowness is one of the problems with our current coverage; sadly enrollment went by before the exchanges opened this year.

                LBJ, Van Cliburn, Ike, Wendy Davis, Lady Bird, Ann Richards, Barbara Jordan, Molly Ivins, Sully Sullenburger, Drew Brees: Texas is NO Bush League!

                by BlackSheep1 on Tue Oct 29, 2013 at 07:35:05 PM PDT

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        •  In order to participate in the ACA offerings an (2+ / 0-)
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          Lily O Lady, JerryNA

          insurance company must meet the items specific to the ACA law.  Some people are upset because they are "losing" their old policy and the cost for the replacement policy under ACA is higher, but here is the difference:
          The old out of ACA policy did not cover items that now must be included in the ACA policy offerings.  (Maternity, hospitalization, cancer treatment, pre-existing condition for example)

          During this roll out problem,, the President would have been more correct to inform us that "existing loop hole filled policies would be replaced with more feature rich policies."  

          Kind of like driving around in a Pinto hoping for the best, when you find out you can get a fully loaded Lexus including a very low interest rate, a small monthly bump up in your payment,and no money down, but you're upset you have to give up your Pinto, and your rate is going up. The thing is with the ACA plans, you don't even have to go with the gold level Lexus, but pick a less expensive option that fills your needs best.  

          "Liberals feel unworthy of their possessions. Conservatives feel they deserve everything they've stolen." Mort Sahl

          by maggiemae on Tue Oct 29, 2013 at 12:15:38 PM PDT

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          •  Probably more to the point, it's not that (2+ / 0-)
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            BlackSheep1, housesella

            the "ineligible" policies don't cover things that must be now covered, but the canceled "low-cost" policies generally have high deductibles, low lifetime caps, large out-of-pocket costs, and are subject to "rescission" at the whim of the insurance company.

            If the President had been pedantic -- which is essentially the criticism now -- he should have said something like, "If your current insurance isn't junk insurance, you'll be able to keep it" rather than, "If you like your current insurance, you'll be able to keep it."  

            If anyone in the White House thought about this issue at all, they probably thought, "Who in the world would like, or want to keep, a policy where you pay premiums but don't get any meaningful coverage?"  The answer to that rhetorical question is, of course, Fox News viewers.

            We must drive the special interests out of politics.… There can be no effective control of corporations while their political activity remains. To put an end to it will neither be a short not an easy task, but it can be done. -- Teddy Roosevelt

            by NoMoJoe on Tue Oct 29, 2013 at 01:14:19 PM PDT

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        •  I believe... (0+ / 0-)

          That inside the exchange they are required to offer those things.

          But not required outside of the exchange.

          Outside the exchange, you do as you have always done: you go directly to an  insurance company and purchase a plan.

          Inside the exchange, you buy the plan through the exchange.

          Which sounds simple, except that (at least for my insurance company that I currently have), the plan names are exactly the same even though what they cover is different, and the cost is different. Which is terribly confusing.

          •  Non-exchange policies (0+ / 0-)

            must offer EHB (the ten essentials) and must meet the medical loss ratio requirements.

            As far as the names go, my experience is that the indivdual policies are being called bronze/silver/metal, and each of those is available in PPO/HMO/HSA.

            It is best to think of these as being offered in exchange and non-exchange varieties, and to remember that they are not the same.

            If you want to buy an exchange policy but don't want to do it online, call the exchange phone number and do it over the phone.

            "Well, I'm sure I'd feel much worse if I weren't under such heavy sedation..."--David St. Hubbins

            by Old Left Good Left on Tue Oct 29, 2013 at 03:09:55 PM PDT

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      •  Jump in the pool (0+ / 0-)

        I'm all for jumping in the pool, because that will make health care cheaper for everyone.

        However, it seems that we don't all have to jump in the pool, because insurance companies can still offer plans that are outside the pool.

        So... how does that solve the "pool has to be really really big for this to work" problem?

        Single payer, please! ;-)

    •  My plan was canceled quite some time ago; I had (1+ / 0-)
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      to switch long before ACA information was available.  Insurance companies can do whatever they want to a plan.  My plan and rate are locked in for 2014, and that gives me a certain feeling of safety. If things change for me, I can change my plan during the next open enrollment.  That is working for me!

      If love could have saved you, you would have lived forever. &

      by weck on Tue Oct 29, 2013 at 01:37:13 PM PDT

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