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Health Care Insurance

bogey21

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I buy a Health Care policy for my oldest Son who is 39 years old. I have been in the habit of buying 360 day Short Term Policies and replacing them with new ones at maturity. Historically Short Term Policies written by Golden Rule (now part of United Healthcare) could be purchased for terms between 30 and 360 days.

The big negative between them and ACA Compliant Policies is that they don't cover pre-existing conditions and are non renewable. Each year you have to apply for a new policy which will be denied if something which can be defined as a pre-existing condition happened during the prior year.

The benefit to me who is paying the premiums is that even after taking into account the penalty for not having an ACA Compliant Policy the cost of a 360 day Short Term Policy is about half that of an ObamaCare Policy and the deductible is not as high.

Well in order to push people like my Son into ACA Compliant Obama Care Policies the prior Department of Healthcare and Human Services passed a rule limiting Short Term Policies to 89 days and will no longer allow one Short Term Policy to replace a maturing one. Naturally I don't like it as I like the lower deductible and cheaper premium.

I understand that rescinding this rule and allowing for 360 day policies and allowing new ones to once again be allowed is now under review. Since my Son's policy doesn't mature until December 14th, I have hope.

George
 

DeniseM

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If Tuggers would like to discuss health insurance - great, but if we start discussing the politics of health insurance, we will have to close this thread.
 

Passepartout

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If Tuggers would like to discuss health insurance - great, but if we start discussing the politics of health insurance, we will have to close this thread.
Impossible. The two are too closely linked.
 

DeniseM

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I know...
 

VacationForever

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Not political. I have Anthem BCBS through the exchange and they just announced that they are pulling out of our state for next year. Our choices are getting fewer...
 

PamMo

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Yep. Humana is pulling out of our state at the end of the year (after others already left). Only one insurer is stepping in to fill the need.
 

bogey21

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If Tuggers would like to discuss health insurance - great, but if we start discussing the politics of health insurance, we will have to close this thread.

No intent to make this political. The primary purpose of my post is to point out that there was a little known alternative to the ACA which as of now has been shut down. The secondary purpose of my post is to make Tuggers aware that if Short Term Health Insurance can again be written for up to 360 days, it may be a less costly alternative for some who understand what they have to give up in exchange for substantial saving.

George
 

Panina

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Not political, just facts....We have only one insurer in our state in the ACA and our rates went up about 40% this year . All the other years we were allowed to use doctors in other states when on vacation. This year only select doctors in our state and not able to use other states unless emergency. Just got denied an emergency ambulance bill saying out of network that was needed when we were vacationing in another state. Husband was bleeding heavy from glass injury. Use to have catastrophe coverage, and even with the deductible cost was less then now.
 

Sugarcubesea

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I was on a conference call today with our broker for our company and our company insurance is going up 8.9%. That is with a reduced benefit policy. Ugh. I feel so bad for those folks that have to self insure.
 

VacationForever

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My issue with Anthem BCBS's withdrawal is that many of the specialists that I am seeing right now do not take the other Exchange insurances. I also checked one drug that I am taking against their drug lists, and it is listed as Tier 4 by the other plans, and it also states that other drugs need to be tried out first as it is non-formulary. I have an illness that I have had for decades and finally found a specialist this year who prescribes a drug that works, unlike the many drugs that I was on before. I am getting stressed over this. It really stinks.
 

vacationhopeful

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MANY, MANY YEARS AGO ... when I had a solo medical insurance policy, a friend/business peer called and asked WHAT I did for health insurance (had a solo policy). She and her husband plus her daughter were looking for coverage; she had a property management company ... had to hold a REAL ESTATE BROKER's license with office and had been pricing to add a group medical coverage policy (for better rates & coverage). All the business policies had a minimum number of workers for any group policy. I joined. And every payment due cycle (it might have been quarterly then), I dropped off a check to her office. And I would throw ALMOST all that type of business to her as a "you help me, I help you" smart move. Then she sold her business to a larger concern and retired ... and that benefit went away.

I found a solo health insurance policy ... cost more but not an ugly amount above my prior arrangement. Ugly came some years later.
 

Passepartout

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Back in the day- before ACA, but before DW & I aged into Medicare, we had little choice but to buy these short-term policies. We would buy one for (iirc) 6 months from Blue Cross, and 6 months later from Blue Shield. Alternating back and forth. But to call them 'health insurance' was a stretch. They didn't 'insure' anything- no preventative care coverage, no prescription coverage, we had to pay the first (thou$and$) before this started picking up perhaps half. And the half was of the full priced hospital or provider billed amount- not the negotiated lower price for the covered in REAL insurance! It was a joke that we sure didn't laugh at. We bought this just as a stop-gap until Medicare kicked in, and boy, I can tell you, we let out a great big sigh of relief when we finally qualified for Medicare!

Yes, there is a place for this short term coverage- if you can't get real insurance it will cover some of the cost if you have a sudden catastrophic accident or illness, but to call it 'insurance' for normal, day-to-day medical coverage, it just isn't.

I will stifle my ire about the 'powers that be' not doing what's necessary to make the nation's insurers feel comfortable staying in the marketplace so that we-us- their customers- feel that we have choice in providers.

Jim
 

SmithOp

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You could roll the dice and go with no insurance, then just pay the ACA penalty if it survives the reform efforts.


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VacationForever

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My issue is before ACA came along there were individual markets where one could shop. Individual markets have disappeared or become invisble. I am going to need to find a broker here to hunt for individual market plans. Last year we came across a rather nasty broker whom my husband refused to deal with and this person was going to research the individual market for me.
 

rapmarks

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I have lots of horror stories with insurance, and they go way back to the seventies. Miscarriage wasn't covered because I hadn't been on the plan nine months. Hospitalization not covered for my three year old with 106 fever because insurance said not medically necessary. ER visit not covered because they said if it really was an emergency, you would have been admitted. The year of hmo hell , when I had h pylori and had to wait several weeks to see the only dr in the system, could not use the nearby hospital and had to drive over an hour, had the dr not give me the medication until my husband was tested and our hmo dr refused the test for him. All the times we went in for an exam and the dr billed it as preventive and insurance wouldn't pay, wouldn't count toward deductible. In 1999 we were paying four hundred a month per person, twelve hundred a month for our family. I feel for the people facing astronomical costs. My daughter works for a health insurance company and has something like five thousand deductible per person with three little kids. But I don't think it was so hunky dory in the past either.


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bogey21

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Back in the day- before ACA, but before DW & I aged into Medicare, we had little choice but to buy these short-term policies. We would buy one for (iirc) 6 months from Blue Cross, and 6 months later from Blue Shield. Alternating back and forth. But to call them 'health insurance' was a stretch.

Not trying to be argumentative here but the short-term policy I bought for my Son from a United Healthcare subsidiary was real insurance. I agree that it didn't have all the bells and whistles of ACA compliant policies. In some areas (particularly its deductible) it was better. Policy holders had access to the entire United Healthcare network. Sure you had to give up some things. On the other hand it was a ton cheaper. In many ways perfect for healthy younger people who were looking for something akin to catastrophic coverage at a relatively low cost.

George
 

VacationForever

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Not trying to be argumentative here but the short-term policy I bought for my Son from a United Healthcare subsidiary was real insurance. I agree that it didn't have all the bells and whistles of ACA compliant policies. In some areas (particularly its deductible) it was better. Policy holders had access to the entire United Healthcare network. Sure you had to give up some things. On the other hand it was a ton cheaper. In many ways perfect for healthy younger people who were looking for something akin to catastrophic coverage at a relatively low cost.

George
Does your son qualify for Medicaid?
 

vacationhopeful

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I finally aged into Medicare .... after MONTHs and then YEARS, of counting the days til I turn 65.

For multiple years prior, I had a group policies for medical insurance ... but got into those groups with 2 different deals/setup ... but reasonable rates. Later even got my own personal coverage thru an insurance company after those associations ended... for a rate I didn't like but NEVER as bad as the ACA.

When the Federal Government mandated insurance coverage for the masses ... . via THE MARKETPLACE ... individual coverage on the open market VANISHED. And the insurance companies NEW line was, "they offered NO Individual Policies" ... "go to the Marketplace ...and get a subsidize policy ... if you qualify".

And that is when I PAID and PAID ... counting the MONTHS til I turned 65. $400 per month NOW is chump change verses the montly $1100-1200+ for crap Marketplace policy which was always cancelled each year. With fewer benefits, higher co-pays, higher deductible and different

PS Now I don't have to ask my pharmacist "who is my doctor this year?". Or get the pharmacist to work their magic to get a script extended (again for BP or collesteral). Or call 3 friends to ask "who are you using the year .. for a doctor office but to see a Physician Assistant?. Actually, my pharm tech graduated HS with me ... her pharmacist really relies on her....he treats me like I am her oldest & bestest friend .. we had home room together for 4 years ... no classes ... not really friendly in HS. I just wish ANY doctor had the same office & location from last "ACA business year".

PSS .. Those "Drop In clinics" (which seem to be everywhere) are setup to be rated by the ACA as "emergency rooms" .. not a doctor's office visit. I know for me, my $150 copay for a office visit is NOT acceptable copay for feeling bad ... plus whatever the medical insurance companies are also paying them
 
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Timeshare Von

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Not political either . . .

Here in Wisconsin it has been a revolving door of companies in the ACA Exchange. Our first carrier (WPS - Wisconsin Physicians) in 2014 decided they didn't like dealing with one hospital/medical group (Froedtert) so they left the Milwaukee County and surrounding areas. We picked up UHC in 2016 at an increase of something like 20%. AND then THEY TOO LEFT Wisconsin in 2017 and now we were left with a choice of two . . . something called Molina (which would not cover Froedtert in-network) and the newly created Childrens Community Network which is a subsidiary of . . . guess who? YEP - Froedtert. My insurance premium increased over 30%!

So to keep our doctors (and I'm still in post follow-up for ovarian cancer, not interested in changing docs or facilities) . . . we really only had the one choice. Molina has already announced they are leaving Wisconsin in 2018. So who knows how much the privilege will cost us next year.
 

rapmarks

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Timeshare von, what is badger care? Hear the term a lot


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PamMo

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DH and I won't know what our rate will be until the new plan rolls out on November 1st. With only one insurer, I highly doubt we'll pay less than the $1,350.32/mo (with $6K/pp deductible) we pay now for the least expensive plan (no dental).
 

wilma

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Don't really understand the purpose of this discussion....people are just complaining about their individual issues but can't propose a solution because that would cross the line into politics?
 

vacationhopeful

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It is a rotten pile to be under.

You feel without voice. Alone. This is called sharing. I know I don't feel like I am as alone.

And that leads toward maybe the future will be better ... as I and other posters are not alone. Or Singled out. Or stupid. Or made a bad choice.
 
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