4 ms·

I've got access to employer numbers. Grandfathered plans are an absolutely screaming deal. You can do an HSA plan with a $2000 deductible and low OOP max, full

I've got access to employer numbers. Grandfathered plans are an absolutely screaming deal. You can do an HSA plan with a $2000 deductible and low OOP max, fully fund the HSA ($7,200) and come out way ahead at modest cost. This let's you do things like vision / dental / chiro / accu / whatever day to day stuff on the HSA, then keep costs controlled (after 2K) for a major issue. If you don't end up using the HSA you can basically use it in retirement. The obamacare bronze HSA plans (which actually cost a bit more) have a $4,800 ind deductible and something like a $13K (!!) out of pocket max and something like a $9K+ family deductible limit. And they cost more. This is totally unworkable absent the subsidies. I like obamacare, but something happened as part of obamacare that has CLEARLY driven up costs. Is it the lack of limits (ie, $10M in coverage during last weeks of life?) Is it some sort of other mandate? One area where govt care is better priced is for the elderly. The grandfathered / free market type plans get expensive at 60 years +. The obamacare plans are more of deal here (relatively). At the 20 year old range obamacare is horrible for the coverage if you actually have to pay for them.

oxymoran 5y ago
It’s the preexisting injury part that jacked up the prices. They aren’t allowed to deny enrollment or charge significantly higher premiums if some was has cancer or something. And that totally makes sense morally, but that causes the risk burden to be offset on the aggregate of the subscribers resulting in higher premiums for everyone. It would be kind of similar to forcing auto insurance carriers to afford coverage to cars they didn’t previously insure after they had already been in an accident.
- onphonenow 5y ago
  I've NEVER seen an employee denied (or asked) about their medical conditions ever. The enrollment paperwork to the carrier is like basic address / name / effective date for coverage. That is it.
  - PopAlongKid 5y ago
    And before ACA, the prospective employee would normally have to show evidence of continuous creditable coverage before being added to the new employer group plan. This is how pre-existing conditions were handled - if you had always had coverage, OK, but if you went uninsured for a while and then tried to re-join a group, tough luck.
  - jaywalk 5y ago
    The ACA prohibits pre-existing condition exclusions for all insurance plans, not just Obamacare plans.
    - KerrAvon 5y ago
      And prior to the ACA rule taking effect, denial for preexisting conditions was common practice. See more here https://en.wikipedia.org/wiki/Pre-existing_condition https://en.wikipedia.org/wiki/Pre-existing_condition
      - dragonwriter 5y ago
        > And prior to the ACA rule taking effect, denial for preexisting conditions was common practice Bigger than denial was recission, where if you ended up with an expensive to cover condition, your insurer would fine-tooth-comb your history for evidence that you had a preexisting condition that has not been revealed, cancel your coverage, and leave you uninsured and uninsurable; recission for reasons other than proven intentional fraud was prohibited by the ACA, which is a pretty big deal.
  - klyrs 5y ago
    I've been at a small company (circa y2k) that looked at group insurance, and decided against it specifically because of one employee's pre-existing conditions would have made the plan more expensive. Boss was a little too forthcoming with that information, and sure enough, when the employee moved on, we all got insured. Thankfully, that's illegal now.
    - 5y ago
- Sohcahtoa82 5y ago
  The insurance mandate was supposed to solve that problem. And the requirement that 80% of premiums paid had to go to paying for care was supposed to prevent insurance companies from jacking up prices to increase profits. Neither actually made an attempt at fixing the underlying problem of health care being expensive.
HideousKojima 5y ago
>I like obamacare, but something happened as part of obamacare that has CLEARLY driven up costs. Is it the lack of limits (ie, $10M in coverage during last weeks of life?) Is it some sort of other mandate? That's an easy one, Obamacare mandated that insurance companies couldn't charge more than X times as much for their most expensive plans vs. their cheapest plans, The people pushing it were either tremendously ignorant or outright lying and claimed that this would make plans cheaper, while critics rightly predicted that instead of making the most expensive plans cheaper they would make their cheapest plans more expensive.
- rrrrrrrrrrrryan 5y ago
  Can't it be both? I'd certainly expect both things to happen, rather than one or the other.
  - HideousKojima 5y ago
    When you've just had the government mandate that everyone in the country has to buy at least the lowest tier of your product, why would you take any losses at the top when people are forced to pay just about any price at the bottom?
- pandaman 5y ago
  This and the cap on the profit margin[1]. The logic in this case is even more bizarre. A regular company can increase its profit either by raising prices or by reducing costs so it strives to do both. An health insurance firm can only do the former. If an insurance firm were to reduce its costs then it would have been forced to reduce the price to remain within the profit margin. But if it increased them instead then it could raise price and get more money in the same profit margin. [1] https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Market-Reforms/Medical-Loss-Ratio https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-In...

oxymoran 5y ago

It’s the preexisting injury part that jacked up the prices. They aren’t allowed to deny enrollment or charge significantly higher premiums if some was has cancer or something. And that totally makes sense morally, but that causes the risk burden to be offset on the aggregate of the subscribers resulting in higher premiums for everyone. It would be kind of similar to forcing auto insurance carriers to afford coverage to cars they didn’t previously insure after they had already been in an accident.

onphonenow 5y ago
I've NEVER seen an employee denied (or asked) about their medical conditions ever. The enrollment paperwork to the carrier is like basic address / name / effective date for coverage. That is it.
- PopAlongKid 5y ago
  And before ACA, the prospective employee would normally have to show evidence of continuous creditable coverage before being added to the new employer group plan. This is how pre-existing conditions were handled - if you had always had coverage, OK, but if you went uninsured for a while and then tried to re-join a group, tough luck.
- jaywalk 5y ago
  The ACA prohibits pre-existing condition exclusions for all insurance plans, not just Obamacare plans.
  - KerrAvon 5y ago
    And prior to the ACA rule taking effect, denial for preexisting conditions was common practice. See more here https://en.wikipedia.org/wiki/Pre-existing_condition https://en.wikipedia.org/wiki/Pre-existing_condition
    - dragonwriter 5y ago
      > And prior to the ACA rule taking effect, denial for preexisting conditions was common practice Bigger than denial was recission, where if you ended up with an expensive to cover condition, your insurer would fine-tooth-comb your history for evidence that you had a preexisting condition that has not been revealed, cancel your coverage, and leave you uninsured and uninsurable; recission for reasons other than proven intentional fraud was prohibited by the ACA, which is a pretty big deal.
- klyrs 5y ago
  I've been at a small company (circa y2k) that looked at group insurance, and decided against it specifically because of one employee's pre-existing conditions would have made the plan more expensive. Boss was a little too forthcoming with that information, and sure enough, when the employee moved on, we all got insured. Thankfully, that's illegal now.
  - 5y ago
Sohcahtoa82 5y ago
The insurance mandate was supposed to solve that problem. And the requirement that 80% of premiums paid had to go to paying for care was supposed to prevent insurance companies from jacking up prices to increase profits. Neither actually made an attempt at fixing the underlying problem of health care being expensive.

HideousKojima 5y ago

>I like obamacare, but something happened as part of obamacare that has CLEARLY driven up costs. Is it the lack of limits (ie, $10M in coverage during last weeks of life?) Is it some sort of other mandate? That's an easy one, Obamacare mandated that insurance companies couldn't charge more than X times as much for their most expensive plans vs. their cheapest plans, The people pushing it were either tremendously ignorant or outright lying and claimed that this would make plans cheaper, while critics rightly predicted that instead of making the most expensive plans cheaper they would make their cheapest plans more expensive.

rrrrrrrrrrrryan 5y ago
Can't it be both? I'd certainly expect both things to happen, rather than one or the other.
- HideousKojima 5y ago
  When you've just had the government mandate that everyone in the country has to buy at least the lowest tier of your product, why would you take any losses at the top when people are forced to pay just about any price at the bottom?
pandaman 5y ago
This and the cap on the profit margin[1]. The logic in this case is even more bizarre. A regular company can increase its profit either by raising prices or by reducing costs so it strives to do both. An health insurance firm can only do the former. If an insurance firm were to reduce its costs then it would have been forced to reduce the price to remain within the profit margin. But if it increased them instead then it could raise price and get more money in the same profit margin. [1] https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Market-Reforms/Medical-Loss-Ratio https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-In...