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View Diary: First Doctor Visit in Five Years: Why Repubs Want Us Broke or Dead (224 comments)

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  •  Let's not forget the companies that "self-insure." (4+ / 0-)
    Recommended by:
    entrelac, fisher1028, Odysseus, worldlotus

    They're gambling you won't get sick.

    I think O'Care has had unintended consequences here but I don't have more than anecdotal info to go on.

    Thump! Bang. Whack-boing. It's dub!

    by dadadata on Wed Mar 26, 2014 at 06:28:12 AM PDT

    •  That is to say, they can offer a "Bronze plan" (2+ / 0-)
      Recommended by:
      NoMoreLies, worldlotus

      that technically qualifies but isn't particularly good coverage.

      Thump! Bang. Whack-boing. It's dub!

      by dadadata on Wed Mar 26, 2014 at 06:29:47 AM PDT

      [ Parent ]

      •  I've been curious about this (2+ / 0-)
        Recommended by:
        kareylou, worldlotus

        There are definitely self insured orgs who will offer the minumum coverage allowable, or close to it, no matter what.

        Self-insured groups are an interesting beast all around. I'll keep an eye out for data on the ACA's impact on them or how they're responding. May be a good diary topic for someone.

        "Words ought to be a little wild, for they are the assaults of thoughts on the unthinking." -Keynes

        by UntyingTheNot on Wed Mar 26, 2014 at 06:48:57 AM PDT

        [ Parent ]

        •  Or ProPublica ... (0+ / 0-)

          Thump! Bang. Whack-boing. It's dub!

          by dadadata on Wed Mar 26, 2014 at 01:56:17 PM PDT

          [ Parent ]

        •  Some searching turns up this: (6+ / 0-)
          Annual Deductible Limit: ACA states that the annual deductible limit applies to health plans offered in the small group market. In the final rule, HHS confirms that ACA’s annual deductible limit applies only in the insured small group market. Thus, the annual deductible limit does not apply to self-insured plans or large group market plans.
          So a self insuring company can essentially offer a cut rate plan that has a deductible set so high you will never reach it. They might offer an alternative plan which isn't affordable in lower wage brackets.

          Bad deal. Needs fixing.

          Thump! Bang. Whack-boing. It's dub!

          by dadadata on Wed Mar 26, 2014 at 04:01:03 PM PDT

          [ Parent ]

    •  I work in an industry where the biggest players (4+ / 0-)

      are self-insured.  What I've been seeing for the past two years is a move away from conventional insurance and a move to HSA only coverage.

      I would also be interested to hear more about how ACA affects the self-insured companies.  These are not small companies and I don't trust what I'm hearing from HR.  

      “To the world you may be just one person, but to one person you may be the world.”-Brandi Snyder (in memory of my Nick)

      by YellowDogInGA on Wed Mar 26, 2014 at 09:10:30 AM PDT

      [ Parent ]

      •  HSA is conventional coverage with high deductibles (4+ / 0-)
        Recommended by:
        JerryNA, worldlotus, AnnCetera, annan

        An HSA policy will have a high deductible/out-of-pocket with an attached savings account that can be donated to by the employee and/or the employer and the donations are tax free as are the payments from the account. Other than that is is more or less the same from a coverage/payment standpoint as a plan with a smaller deductible/OOP.   For anyone who does not have large medical expenses, say the young, it tends to be a good deal.  The premiums are lower and the difference can be directed to the savings account and over time should build up to a nice sum that will be available for future illnesses.   For those who meet the deductible every year it is usually not as good a deal, although the difference between the premium, employer contribution and tax savings usually is pretty close to the deductible.  There are always winners and losers in any setup.  

        It has nothing to do with self-insurance, most employers offer it as one of the option these days.  The idea is that having the money will make employees think twice about medical expenses.  Whether that is a good idea or not is another matter, but studies seem to indicate it is.

        Self-insurance is covered under the ERISA laws.  I believe that plans still have to met the coverage requirements of the ACA, but I am not positive about that.

        Most companies that are more than a few hundred employees self-insure.  It is not always obvious because they hire someone else, often an insurance company, to manage the plan and there is usually a PPO attached as well.  So your ID card says Blue-Cross, but the insurer (the person responsible for paying) is really your employer.  

        The difficulty lies not so much in developing new ideas as in escaping from old ones! - John Maynard Keynes

        by Do Something on Wed Mar 26, 2014 at 02:38:19 PM PDT

        [ Parent ]

    •  Not exactly how that works (2+ / 0-)
      Recommended by:
      JerryNA, worldlotus

      They are gambling that their experience over the total population of employees will be better or equal to what the actuarial tables predict.   This works because once you reach a certain size the statistics usually work out.  In case they don't a self-insurer will have a policy that protects them if an individual or the aggregate cost exceeds a certain claim amount.  

      There a several ways that a self-insured company saves.  They are not paying the insurance company's profit.  They are not paying the sales commissions.   They can tailor (for better or worse) the plan to meet the needs and contours of their employees (that is one reason it is important to have required things covered).

      In the end self-insured companies are closer to the ideal.  What is paid out is what is incurred in claims plus some expense of running the plan.  Not a lot of expenses that have nothing to do with healthcare (like profits, commissions, etc.).  Not perfect and certainly subject to manipulation and motivations other than just providing healthcare, but often a better choice.

      The difficulty lies not so much in developing new ideas as in escaping from old ones! - John Maynard Keynes

      by Do Something on Wed Mar 26, 2014 at 02:26:34 PM PDT

      [ Parent ]

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