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As a freelance programmer, I've bought my insurance on the private market for the past couple of years. I actually have a decent low-cost plan with Humana that exceeds the quality of the bronze level plans in the exchange.

The problem: Humana doesn't offer that plan on the exchange, or anything like it. They offer 1 plan at the bronze level that costs twice as much and has a nearly $5,000 a year greater maximum out of pocket cost, with the same deductibles.

As a matter of fact, there are only 3 companies offering bronze level plans in my area, and the least expensive plan is $60 more a month than my current plan for less coverage.

Not to offer a promo for them or anything, but I had been buying my health insurance online from ehealthinsurance.com, and there were many more choices available there than on the exchange (I recall at least 7 or 8 companies with plans, possibly more). And dollar for dollar, the coverage was better.

Thankfully, I received a letter from Humana last month that I can keep my coverage for next year. But I'm a little worried about if that's going to be the case going forward, or if the exchanges are going to displace the rest of the market. And why are there relatively few plans and few providers in the exchange compared to the existing market?

What's been your experience with the exchange?

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Comment Preferences

  •  Yes . (2+ / 0-)
    Recommended by:
    Victor Ward, Liberal Jon

    "please love deeply...openly and genuinely." A. M. H.

    by indycam on Thu Nov 14, 2013 at 07:01:57 PM PST

  •  Define "less coverage" (1+ / 0-)
    Recommended by:
    Liberal Jon

    "I can't come to bed yet! Someone is WRONG on the Internet!" - XKCD

    by SingularExistence on Thu Nov 14, 2013 at 07:51:00 PM PST

    •  Less coverage (1+ / 0-)
      Recommended by:
      Victor Ward

      Same deductible.

      $5,000 more maximum out of pocket costs per year.

      30% coinsurance vs. 0% beyond deductible.

      No coverage at all for out of network care, vs. 80%.

      Premiums starting at $60 more a month. The cheapest Humana plan is more than twice what I pay now for a better plan from them, e.g.!

      •  Am I reading this right, you are getting (1+ / 0-)
        Recommended by:
        Liberal Jon

        Quoted a higher price from the same insurance company you currently purchase insurance from?

        •  Yes, exactly (1+ / 0-)
          Recommended by:
          Victor Ward

          The Humana plan I have is better than the Humana bronze-level plan offered through the exchange, at half the price.

          The closest bronze-level plan has all the (worse) features described above, and is 50% more expensive than my current plan.

          I don't know why Humana charges twice as much for worse coverage than I currently have, but I suspect they're charging more because only 3 insurers are competing (vs. at least 8 in the private market) and because they can because people get subsidies on the exchange and not privately.

          But either way, it's true. Humana is price-gouging in my view, at least for my city and situation.

          •  So the plans on the exchange in your state (1+ / 0-)
            Recommended by:
            Liberal Jon

            Are catered specifically to a financial class of people who would get government subsidies for health insurance.

            At least the government doesn't pay a monthly stipend to insurance companies for Medicaid.  They only pay for necessary health care.  

            It seems to me that if the government starts paying monthly subsidies to insurance companies for health insurance that will effect our taxes in the long run.

            Very bad idea and didn't consider that scenario until just now.  Thanks for that.

      •  Does the plan you have now (0+ / 0-)

        Have yearly and/or lifetime caps? The ones you buy on the exchange will not have that, which can be a very big deal if you get very injured or sick.



        Women create the entire labor force.
        ---------------------------------------------
        Sympathy is the strongest instinct in human nature. - Charles Darwin

        by splashy on Fri Nov 15, 2013 at 06:43:19 AM PST

        [ Parent ]

  •  My experience was about 90% positive (0+ / 0-)

    I tried the first week and after getting through registering a name and password it was stuck.

    I tried again the last week of October.  Name and password worked, it completed all the registration, but it was slow.  Also, I would give it low marks on not being very obvious as to where you were supposed to click next.  It gave me 22 plan options!  That was a bit overwhelming.

    I downloaded plan summaries, provider networks, and went to other sites for tips and advice on how to pick a plan.  For me, choosing was the hardest part.  This might be due in part to the fact that I have never had health insurance before and was not familiar with some of the terminology.

    With a choice finally made, I logged back on today.  It took about five minutes to enroll.  More than half of that time was spent on dental care options.

    For me the website worked.  It had glitches and there is HUGE room for improvement.  Despite that, I am 100% satisfied with the final outcome.

    •  No, the website works fine (1+ / 0-)
      Recommended by:
      Victor Ward

      My state runs its own website, and it never had the problems of healthcare.gov.

      But how do the plans offered compare to your existing plan?

      If you haven't shopped on the individual market in your state before, you might be surprised. In my area, there are hundreds of plans to choose from, from at least 8 different companies.

      On the exchange, there are merely dozens of plans to choose from, offered by 3 insurers (expanding to 4 in the pricier market).

      So my issue is not with the website, which is a minor temporary glitch, but how the competitive experience compares to the existing market where you live?

      For me, the competition on the exchange is much less and the prices higher.

      •  I understand your concern (2+ / 0-)
        Recommended by:
        Liberal Jon, buffie

        Frankly, I was surprised that despite being offered 22 different plans, there were only TWO companies.  You got 50% more competition than me!

        I did some research.  I'm not saying this is definitive, but it's the impression I got.  Each state was divided into Rating Areas.  Insurance companies then offered plans and premiums in those Rating Areas.  Of course they could choose to offer nothing in a particular Rating Area.

        Texas may not be completely fucking weird in this regard, but it looked weird to me.  It made 25 Rating Areas which were basically the SMA's (statistical metropolitan area) and then lumped all the rest of the counties into Rating Area #26.  That includes me, and it includes counties that are a lot further apart than Los Angeles and Denver.  Weird!

        I can't compare my new plan to my existing plan.  I've never had health insurance before.  For me, Obamacare works.  On the other hand, I can understand your frustration if you feel that you are truly comparing oranges to oranges and apples to apples and are coming up with a deal that isn't as good as what you had before.

      •  But I bet the exchange plans don't have caps (0+ / 0-)

        Like the ones that have been offered.



        Women create the entire labor force.
        ---------------------------------------------
        Sympathy is the strongest instinct in human nature. - Charles Darwin

        by splashy on Fri Nov 15, 2013 at 06:44:41 AM PST

        [ Parent ]

  •  The insurers chose which plans for the exchange (3+ / 0-)
    Recommended by:
    ImpactAv, Sunspots, arlandbaee

    The plans in each county of each state are those the insurers chose to put on the exchange.  Those insurers and others have more plans that are available through on-line or local insurance brokers.

    The exchange is mainly for those who'll qualify for a subsidy.  Look at the exchange plans and look at the off-exchange plans.  Pick the one that best fills your needs.  In my state a broker can enroll people in any of the plans available in my county including the subsidized exchange plans.  Your state may be different.

    •  But why? (1+ / 0-)
      Recommended by:
      Victor Ward

      I mean, if you allow a greedy insurance company to pick and choose what they'll offer on the exchange with federal subsidies, doesn't it stand to reason they'll offer more expensive, potentially less valuable plans on the federal exchange because of those federal subsidies?

      So let's say they could really afford to offer a particular plan at $100 a month, why not continue to offer that plan for private customers, but charge $200 for the same plan on the federal exchange, because you know most of the customers there will buy with federal subsidies, or buy from you directly without the subsidy?

      Basically I feel like the federal exchange offers carte Blanche for insurers to gouge people because of those subsidies. And if there are enough people getting those subsidies, those without subsidies will get shut out.

      I'd feel a lot better about the potential for price gouging if there was a public option. But there isn't, and they can gouge away.

  •  "17 percent of U.S. counties - just one insurer (1+ / 0-)
    Recommended by:
    HeyMikey

    has a monopoly on the subsidized exchanges."

    In 78 percent of U.S. counties, customers have a choice between three ACA insurers or fewer. And in 17 percent of U.S. counties – including all counties in New Hampshire and West Virginia – just one insurer has a monopoly on the subsidized exchanges.

    In 31 of the 50 states, not a single customer has a choice on the exchange of more than four insurance companies.

    In 21 states (including five of the six New England states and five Southern states), no customer has a choice of more than three insurers.

    http://theincidentaleconomist.com/...

    I'm sure it's just an accident that all these medical insurance companies are not offering their product on exchanges...Click the link for the lack of competition in markets before Obamacare. Spoiler alert: "A significant absence of health insurer competition exists in 83 percent of metropolitan markets studied by the AMA."

  •  It depends (0+ / 0-)

    Here in RI, the exchange has two companies -- Blue Cross, and the Neighborhood health clinic system. I'd like to see it include more, and would like a public option, but apparently the other insurers didn't consider it worthwhile jumping through the hoops for a relatively small market.

    If you are young and healthy and over the subsidy limit, the off-exchange market may work fine for you, and may actually work better than the exchanges.  But if you have any kind of a medical issue, you are likely to discover that there are seriously low caps on what they'll cover, and then they will refuse to renew you -- that's how they keep premiums low, is by screening out anyone who needs the coverage.

    The argument for driving all individual buyers into the exchange is to make sure that the exchange policies aren't loaded toward old sick people (the famous "death spiral"). So your interest as a buyer (the cheapest policy that will cover your likely needs) conflicts with the actuarial needs of the insurance system, which is to average out premiums across the whole population since they're no longer allowed to charge extra for sick people ("pre-existing conditions").

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