Next Week!

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Open Season starts next Wednesday.    Yup.  I’ve warned you for the past two months to make sure that you knew your password and all your information was up to date.  Because starting next Wednesday, it’s going to be crunch time.

Open Season

And, TheDonald killed the advocate program- so you are on your own.  Top that off with cutting open season more than in half (it now starts 1 November and ends 15 December).  Oh, wait-  the website will also be closed on Sunday. [Supposedly for maintenance- yeah, right- on the site’s busiest day of the week, and like labor is cheap on Sunday.])

Don’t forget that you (if you are a female) will probably have to check WAY MORE carefully into your choice of  plans- since TheDonald killed the requirement that the plans include birth control, too.

There’s more- of course.  The GOP plans to slice about $ 1 trillion from Medicaid- and $1/2 trillion from Medicare.  So, they can use that money for their tax cuts for the rich and for corporations.  So, it may be tougher to get that coverage that you need.  (So much for truth from TheDonald.  His current alternative fact- his campaign promises (repeatedly) about not cutting Medicare… not so true.)

Yes, I know that TheDonald has avowed to kill the health insurance subsidies.  Because those payments may be  contrary to Federal Law.  And, yes, a Federal judge had already agreed that these payments need to be approved by Congress- but there was an appeal in progress.  And, you can bet that at least 20 state Attorneys General will be filing (separately and/or together) lawsuits forcing the continuation of the subsidies.

(By the way, those MEWA’s being promoted by TheDonald.  They absolutely suck.  Sure, folks will take that the larger firms use these routinely to insure their employees.  That’s absolutely true.  Because they re-insure (that means there is also a stop-gap, a safety net) the larger firms.  These firms have computed that they can save money by covering the initial health care costs and defer to the insurers to pick up the tab for larger bills.  That keeps their premiums low.  Who’s going to cover your initial costs?   Where will you get that money?  And, when smaller firms used these programs before, they often defaulted, leaving you with some bills- or, much worse, the MEWA’s filed for bankruptcy.  Leaving you with the large bill upon which they defaulted.  Oops….)

This is exactly why I recommended all of you go the  PPACA site.  Now- before next Wednesday!  Make sure you remember your sign-on and password.  (I always remember my sign-on, I almost always forget my password- or, it has already expired, since it doesn’t survive 12 months…)   So, that now- when there are fewer people traversing the site (it’s not open season yet), you can make sure you will have easy access, when you need it, starting next Wednesday (1 November).

If you already insured by PPACA, click on this link, once you are in.   This should provide you with the costs for next year’s plan.  And, give you time to examine alternative plans that provide the same- or better- coverage for less money.

(When I was participating in Obamacare [being an old fart, I am now on Medicare], my plan increased by 25% in year 2- so I switched to an alternative plan [having the same doctor choices and coverage] for a few pennies different.  And, year 3, with a similar price increase on the horizon, I switched back to plan 1- for, actually, a lower price than I paid in year 2.)

Please, please, please do this!   Because you probably don’t realize another shenanigan that has been perpetrated…  If you do nothing, you may find you have been re-enrolled in the same plan.  With those higher rates.  (You probably don’t recall agreeing to automatically re-enroll.  You did.)  And, that re-enrollment this year happens AFTER the open enrollment period has expired.  So, you won’t be notified of your error (it’s YOUR error if you do nothing), until it’s too late.  When you can’t get that better or same plan at a lower rate.

And, now that the subsidies have been removed (not necessarily permanently, as I discussed yesterday), it’s pretty clear that the premiums for the middle class folks could be fairly steep.  Still cheaper than they would have been prior to the passage of PPACA, but steep.  So, you may want to consider a high-deductible insurance plan under PPACA.

Those higher deductible vehicles have much lower premiums- but there are higher out-of-pocket costs.  An example would be a $ 2800 deductible and 70% of the costs covered by the plan. Once the deductible is met, the 70% coverage kicks in- but you do get the bulk buying rates (lowered costs for doctor visits, pharmaceuticals, and hospital visits) with this plan.  You don’t get the lower practitioner and drug costs with those terrible catastrophic health plans that TheDonald has been touting.  [And, nothing is stopping you from purchasing a conventional plan with a $ 500 or $ 1000 deductible, that covers 90% of the costs- except for those higher monthly premium rates.]

(Choosing a high deductible plan also provides one the legal right to put $ 3400 in a health savings account (HSA).  [It’s actually $6750 for families].  Oh, if we are older than 55, those limits go up by a grand.  If you don’t need to use the funds in a given year, they can keep accumulating- like a 401(k) or IRA plan.)   You can expect to save some $ 1300 to $ 2000 a year (in premiums) for these high deductible plans.  Which savings should be funneled to that HSA, to cover any health costs that are not covered by your plan.)

Medicaid expansion covers the uninsured

Remember, you are unable to elect a new health plan until 1 November.  Even so, that change won’t take effect until 1 January 2018.  But, given the cuts in budget, cuts in call center staffing, etc., you need to ensure you have quick and simple access.  So, update your information- NOW.

One last fact, given the subterfuge and confusion that is abounding.  It IS possible that the subsidies will terminate.  and, that could make insurance for those on the bottom end of the insurance ladder very expensive.  But, sign up anyway.  Because if there is no subsidy, you can simply NOT pay for the insurance and will have no further obligation.  (The program stipulates if you don’t make payment before January, you have opted to not continue or start your insurance. )   But, if you don’t act during open season and the rulings – or Congressional action- stipulate the continuation of the subsidies in mid-to-late December, it will be too late for you to sign up and get insured- with those subsidies fully funded.

Again, it’s not just the fact that you are covered for any illness or accident, as stated above. You are joining a “buying club”.  When you have insurance, your plan has arranged what amounts to discount rates for physician visits and drugs.  That alone makes any real (i.e. not a catastrophic plan) healthcare plan a great deal.

Roy A. Ackerman, Ph.D., E.A.

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12 thoughts on “Next Week!”

  1. Even though I disagree with your political commentary, I will admit that acting within deadlines to explore one’s options is wise and that your helpful hints for doing that will be useful for those who need to shop for a plan. I’ll be shopping for a new Medicare plan if I can find one I can afford that lets me skip the primary provider’s referral to see a specialist.
    Barbara Radisavljevic recently posted..Wordless Wednesday: The Next Generation of Milk Thistle

    1. You may disagree with my political commentary- as is your right, Barbara. However, I have become more strident as I see TheDonald emulating the regime with which we are not supposed to compare any leader- from his embracing of the “Big Lie” to his racist, misogynist, and repressive sentiments. I can’t sit back and be silent. My compatriots were decimated the last time someone suggested they be quiet and hope for the best.

      And, I don’t think there is a Medicare program (or even an ACA system) that lets one bypass a primary provider to see a specialist. Without taking a financial hit. I chose my primary provider because he is both a respiratory specialist AND an internist. His group includes a gynecologist who is also an internist and a cardiologist who is also a family physician. That’s the sort of route you probably will need to take.

  2. Health care coverage as a convoluted process. Trump has failed with “repeal & replace” so he’s purposely trying to crash the ACA by making it impossible to sign up. Ummmmm, so Donald Trump is not exactly my favorite person.

    1. I won’t saddle Trump with repeal and replace- it’s been the mantra of virtually every single GOP member of the House and the Senate, Alice. But, Trump is trying his damndest to trash the ACA with his executive orders. Interestingly, not a peep from the GOP about all these executive orders, despite their protestations of the GOP against Obama. By the way, Obama issued the lowest number of executive orders per year since Grover Cleveland. His first term- his two terms were separated by four years. And, Trump has doubled Obama’s level- and it hasn’t been a year yet!

  3. And “that discount” (the negotiated price for a service) can be quite substantial. Still, so many find themselves in the same position as my son is in – they have to get insurance, but can’t afford to use it (and he has preexisting conditions, on top of that). But why break a program to fix it? Politics, of course. Politics. And politicians who, bluntly, just don’t care.
    Alana recently posted..Fall Fancies – Fall at Last

    1. So, the pre-existing situation does not pertain at all on the marketplace, Alana. He should be fine. Now, the subsidies may not exist this year. And, given how some states are arranging things, it may pay to examine the gold standard (above silver), since many of the firms are saddling the silver plans with the cost of the subsidies- and not the gold.

  4. If it wasn’t for the subsidies that Ohio opted in for, I doubt my granddaughter would have gone to the doctor last year when they found a massive tumor that had infiltrated her spinal cord. I don’t even want to think what the outcome would have been.
    Martha recently posted..Front Porch Chat

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