as most of you know, my wife and I carry and have carried individual, private plans - we have done so for about 6 years. We do the "guarantee dodge". Anthem guarantees no rate increases for 6 months, Cigna does the same, for a year, so we shift back and forth - it saved us quite a bit over the years. The "doctor" underwirters are asholes so we have to go through that gauntlet every 6 months or year but fine and now we know what we are doing. Regardless, our combined premiums have reached about 800 a month. I perused the exchange and found that I could get the combined bill down to three hundred dollars. Sure, the deductable was larger, sure the out of pocket was higher but I could pocket the difference for a while and defray those deductables with what I saved in premiums.
So far so good, but I got into the details this week. I started the new plans in motion just in case, because I knew that increases were coming. My wife got a letter dated the 16th saying that she would get a 20 percent increase on the 1st. Only we got the letter on the 1st. Within the body of the letter was a statement saying that we should take advantage of their new policy before the 15th - mind you the body of that letter was dated the 16th.
Now there are three little known provisions of the ACA.
They tax insurance companies and self insured companies.
Fees Included : • ACA Insurer Fee$13.07 • Reinsurance Fee$9.49 • Exchange Fees$14.96
Looks kinda like a telephone bill doesn't it? These "fees" are federaly mandated and are based on the size and customer base of the insurance company. the feds explicitly stated that the fees were to come from the coffers of the company itself (given that the consumer has no control over the size of the company he or she opts to engage for services) BUT!!! there is nothing in the law that prevents those companies from passing those "fees" on to their customers, which is exactly what they did. Along with that, they instruct those customers that those fees are federaly mandated (blaming the ACA for the increase). Now I could not even get an answer as to what an reinsurance fee was, nor could I get an answer as to why these fees were on going, month to month. Furthermore. I am shopping outside of the exchange, so why should i pay an exchange fee? Hmmm? but that is just the way it is.
and, by the way, those fees are not reflected in the comparisons of premiums. Should I select a 500 dollar plan i will be billed not only the 500 but the fees, AFTER the fact, I will not be informed of the extra until my bill comes due.
Now, let's talk about network coverage. I spoke to cigna and anthem. both assured me that the exchange plan and the individual plan were IDENTICAL in every way save the name of the plan and the elegibility for subsidy (both claimed wrongly that the subsidy was sent to the consumer rather than being remitted directly to the insurer - so they couldn't be sure they would get their money - now THAT was a joke - poor poor insurance companies). IDENTICAL. Indentical in covererage, premium, out of pocket, maximums, AND.... AND network. But that isn't what my provider tells me. "no, we will not take ACA plans from anthem or cigna, only healthnet. I spoke to their broker and he was clueless except to repeat what I was already told.
Notice that you are asked for your zip code when you apply or shop. I asked why, they said it was because different zips had different networks. "my network hasn't changed, my address hasn't changed, why do you need that? "it has a bearing on the price you will pay". "why? isn't that redlining"? "I do not know sir, and I do not know what redlining is". It turns out that your location has a bearing. the more people in your zip who get cheaper policies, the more they bump your premium - redlining.
Now Anthem projects it's policies AS THOUGH you were purchasing them from the exchange. They offer plans and premiums that look identical to Exchange policies including estimated subsidies. How nice! I can simply go here and skip the exchange and all its glitches. except that if I do so, it says in the very fine print on another page, I will forgo the subsidy, and pay the tidy sum of $1120 a month.
Oh there is more. Any misspelling of the url for either the exchange or the state exchange sends you to a scam site.
