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Timby posted:This is actually legal now on employer-provided plans. My company just changed its insurance offerings this year and explicitly says that any claims filed for injuries or illnesses "resulting from drug or alcohol abuse, or other lifestyle choices" will not be covered. This violates both the mental health equity act of 2008 as well as the ACA. Can’t deny substance abuse treatment. Denying medical coverage for the complications of drug abuse will result in fewer people getting treatment.
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Dec 2, 2017 17:22
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Timby posted:This is actually legal now on employer-provided plans. My company just changed its insurance offerings this year and explicitly says that any claims filed for injuries or illnesses "resulting from drug or alcohol abuse, or other lifestyle choices" will not be covered. That standard is a little bit more concrete than a bunch of fundies denying you expensive care and trying to get out of it with a flimsy religious justification
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Dec 2, 2017 17:25
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Timby posted:This is actually legal now on employer-provided plans. My company just changed its insurance offerings this year and explicitly says that any claims filed for injuries or illnesses "resulting from drug or alcohol abuse, or other lifestyle choices" will not be covered. Ah, like obesity. Well we'll see how far the insurer gets with that until they get sued out of existence.
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Dec 2, 2017 17:41
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The Phlegmatist posted:Ah, like obesity. Well we'll see how far the insurer gets with that until they get sued out of existence. It's not the insurer making that decision, it's the employer.
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Dec 2, 2017 17:53
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How does that even work? My employer provides me with insurance but as far as I know that's the end of the story. My health insurance doesn't provide my employer with any information that I haven't okayed and I'm pretty sure doing so would be a violation of hipaa.
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Dec 2, 2017 18:07
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So assuming the skinny ACA repeal in the GOP tax bill makes it and gets signed into law, how will that affect people currently using the ACA for health insurance (like me)? I want health coverage even though I'm healthy now so the mandate never mattered to me. I know premiums will go up, but what else?
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Dec 2, 2017 21:04
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clockworkjoe posted:So assuming the skinny ACA repeal in the GOP tax bill makes it and gets signed into law, how will that affect people currently using the ACA for health insurance (like me)? I want health coverage even though I'm healthy now so the mandate never mattered to me. I know premiums will go up, but what else? The protection / requirement for insurers to cover pre-existing conditions is subsidized by literally everyone having insurance (the mandate). By repealing the mandate but still requiring insurers to grant coverage for pre-existing conditions means the entire system is now financially hosed and individual insurance will be completely un-affordable.
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Dec 2, 2017 21:23
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Lote posted:This violates both the mental health equity act of 2008 as well as the ACA. Can’t deny substance abuse treatment. Denying medical coverage for the complications of drug abuse will result in fewer people getting treatment. How do you think this would go in court post hobby lobby?
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Dec 2, 2017 21:37
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The difference is that hobby lobby wanted to be able to offer plans that don’t cover procedures they find icky. This company supposedly wants to offer plans that cover, say, heart surgery, but not if you got it because you ate too many Big Macs— which they can’t know unless they have access to patient records, which is a HIPAA violation.
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Dec 2, 2017 22:49
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Timby posted:The protection / requirement for insurers to cover pre-existing conditions is subsidized by literally everyone having insurance (the mandate). By repealing the mandate but still requiring insurers to grant coverage for pre-existing conditions means the entire system is now financially hosed and individual insurance will be completely un-affordable. Aren't the subsidies supposed to scale with the cost of a silver plan?
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Dec 2, 2017 23:01
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hobbesmaster posted:How do you think this would go in court post hobby lobby? The Mental Health and Addiction Parity Act quote:If a group health plan or health insurance coverage includes medical/surgical benefits and MH/SUD benefits, the financial requirements (e.g., deductibles and co-payments) and treatment limitations (e.g., number of visits or days of coverage) that apply to MH/SUD benefits must be no more restrictive than the predominant financial requirements or treatment limitations that apply to substantially all medical/surgical benefits (this is referred to as the “substantially all/predominant test”).This test is discussed in greater detail in the MHPAEA regulation (linked below) and the summary of the MHPAEA regulation found below. I would imagine that it would be struck down because Hobby Lobby relied on a 1st Ammendment and religious expression argument. I don't think an argument of "I have a religious objection to drug use, therefore I will not pay for addiction treatment" because that would worsen addiction. It could also open up the employer to liability if let's say a truck driver were alcoholic and tries to seek addiction treatment and is denied and then subsequently gets into an accident. If you deny coverage of drug related diseases, you're denying coverage of HIV, Hepatitis C, heart infections, kidney infections, strokes / brain injury / paralysis, etc. If a substance abuse treatment center says they can't take care of a person because they have an opportunistic infection of AIDS, what is that person supposed to do? I can see an argument and have seen the insurance company compell someone to substance abuse treatment in order to cover paying for treatment of the sequelae. Realistically, if this stuff happens on a wide level with blanket denials of coverage for treatment for Hepatits C, diabetes, HIV, etc., doctors are just going to stop ordering urine toxicologies and BACs. You can't prove 100% where you got Hepatits C or HIV or a heart infection or liver failure.
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Dec 2, 2017 23:10
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clockworkjoe posted:Aren't the subsidies supposed to scale with the cost of a silver plan? Trump killed the CSRs with an executive order. Alexander-Murray was supposed to restore them for something like a two-year period while tax reform was worked out, but of course the White House said that would never loving happen. Collins, Murkowski and McCain flipped on the tax bill because they received "promises" from Senate leadership and the White House that the restoration of CSRs, Alexander-Murray-style, would happen soon. But they're either idiots or they were just posturing all along. It's also a poison pill for Democrats, because Alexander-Murray needs to get 60 votes. Timby fucked around with this message at 23:14 on Dec 2, 2017 |
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Dec 2, 2017 23:12
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Yeah, subsidies will scale to offset the extra costs, but some providers might drop out of the market if they get too jittery. Some states might implement there own mandate, or some other mechanism to replace it. Red States most likely won't. Collins got "assurances" that Alexander-Murray and a bill offering reinsurance funding would be passed if she voted for the tax bill to help stabilize the markets, but Alexander-Murray would just give states a little more flexibility and offer more catastrophic plans and the reinsurance might not be enough to offset the absence of the mandate. Depending on what gets attached to the Continuing Resolution coming up you could see Arkansas, Iowa and other recalcitrant states start tinkering with their ACA markets in a variety of subtly dickish ways, but that depends on how things go in 2018. Trump and a lot of GOP'ers still want to destroy the ACA, but state governments "might" take a more productive approach.
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Dec 2, 2017 23:14
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PerniciousKnid posted:I don't know if he's looked at the marketplace, he just mentioned offhand that he was considering health share and that caught my attention. His pension is like 16-18k I think, and he probably has some small investment income. Today I learned that being in the 18mo COBRA eligibility people disqualifies you from subsidies.
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Dec 3, 2017 06:18
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PerniciousKnid posted:Today I learned that being in the 18mo COBRA eligibility people disqualifies you from subsidies. No it doesn't. Being enrolled in a COBRA plan means you can only switch to a market plan during open enrollment periods, but simply being eligible for coverage should not cause issues with subsidies or choosing a marketplace plan.
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Dec 3, 2017 14:47
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esquilax posted:No it doesn't. Being enrolled in a COBRA plan means you can only switch to a market plan during open enrollment periods, but simply being eligible for coverage should not cause issues with subsidies or choosing a marketplace plan. Hm, then he got some information from, or was merely confused by what he heard from an advisor. He and I were very confused because healthcare.gov didn't show him getting any tax credits, but I eventually realized it's because he owed further information about eligibility because he told his advisor he didn't know yet if he was eligible for COBRA* or to buy into the plan at his wife's work (she works part-time at a school). I wonder if it's being potentially able to buy into his wife's plan that disqualified him, or if it's just that the advisor put in a TBD for those questions even though either answer would permit subsidies. I guess that he would have to send some kind of paperwork from both sources about what he's eligible for as part of his ACA eligibility form requirements. Even his advisor was surprised by the costs being shown. *He misunderstood a mandatory COBRA re-enrollment form as being necessary to mail in only if changes were being made to his COBRA enrollment, so COBRA dropped him last month and now he's trying to get back in. So he told the advisor he doesn't know if he's eligible.
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Dec 3, 2017 15:40
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PerniciousKnid posted:Hm, then he got some information from, or was merely confused by what he heard from an advisor. He and I were very confused because healthcare.gov didn't show him getting any tax credits, but I eventually realized it's because he owed further information about eligibility because he told his advisor he didn't know yet if he was eligible for COBRA* or to buy into the plan at his wife's work (she works part-time at a school). I wonder if it's being potentially able to buy into his wife's plan that disqualified him, or if it's just that the advisor put in a TBD for those questions even though either answer would permit subsidies. I guess that he would have to send some kind of paperwork from both sources about what he's eligible for as part of his ACA eligibility form requirements. Even his advisor was surprised by the costs being shown. So - I was inexact before. Being eligible for COBRA could prevent subsidies, but only if the premium rates for COBRA are affordable based on his income. COBRA rates are generally unaffordable, so it usually wouldn't make a difference. But the possibility of this rare occurrence does mean that a "Yes I am eligible for COBRA" answer on that question might lead to a further question on whether the available COBRA coverage is affordable. Not familiar with the system they're using so I can't say for sure. The ability to buy into his wife's plan could also potentially make him ineligible for subsidies on 1/1/18. If her coverage through them is affordable based on their family income but his is not, he could be a victim of the "family glitch"
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Dec 3, 2017 17:11
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esquilax posted:So - I was inexact before. Being eligible for COBRA could prevent subsidies, but only if the premium rates for COBRA are affordable based on his income. COBRA rates are generally unaffordable, so it usually wouldn't make a difference. But the possibility of this rare occurrence does mean that a "Yes I am eligible for COBRA" answer on that question might lead to a further question on whether the available COBRA coverage is affordable. Not familiar with the system they're using so I can't say for sure. That's good to know, thanks. I guess he'll have to bring the premium info to the advisor and finish his application to find out if he gets any subsidies. He was asking me yesterday, "how do people without nest eggs and with kids afford this?" And I was like, "... They don't".
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Dec 3, 2017 18:56
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with the individual mandate likely done, will catastrophic plans or better priced insurance be offered?
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Dec 15, 2017 23:19
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Hahahahahaha. More like everyone's insurance is gonna go up when young healthy people leave the market.
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Dec 16, 2017 02:49
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Probably, but they won’t be affordable since everyone that doesn’t want insurance is going to drop their plan like it’s a beehive. At least until the economy tanks from it and all the insurance companies pull out.
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Dec 16, 2017 02:51
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Arkane posted:with the individual mandate likely done, will catastrophic plans or better priced insurance be offered? They'll still have to compete with subsidised market plans.
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Dec 16, 2017 05:18
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PerniciousKnid posted:They'll still have to compete with subsidised market plans. We have a pretty healthy nongroup off-exchange market in FL. They're for people who don't qualify for subsidies anyway. But they're ACA compliant. There's a potential that we'll see non-ACA plans offered off-exchange now that you don't get the individual mandate tax penalty for having a non-ACA plan. Maybe.
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Dec 17, 2017 19:18
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WA State runs it's own exchange, the deadline for Open Enrollment is Jan 15th, and I just bought my plan for 2018. The Gold Plan was one dollar cheaper than the Silver Plan, from the same health insurance company (Kaiser-Permanente), because  . Consequently, I now have fancy insurance.
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Jan 4, 2018 22:36
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Qu Appelle posted:The Gold Plan was one dollar cheaper than the Silver Plan, from the same health insurance company (Kaiser-Permanente), because From what I understand, this is because insurers raised the cost of their silver plans due to not getting CSR payments anymore, but didn’t do so on the bronze or gold plans; since the subsidies are based off of the second-cheapest silver plan available, this had the effect of subsidizing non-silver plans more than silver plans. Or something. Either way, grats on your not-lovely insurance!
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Jan 5, 2018 03:27
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It's darkly amusing that the Republican attack on Obamacare is actually decreasing out-of-pocket costs for people. Also darkly amusing that Democrats trying to be "fiscally sensible" just ended up making things worse for people for no reason and not only did they not get credit for their financially sound planning, it actively hurt them because Republicans called them spendthrifts anyway and then turned around and took the opportunity to spend even more federal dollars in a way that actually helps people so they can take all the credit.
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Jan 5, 2018 03:43
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VitalSigns posted:It's darkly amusing that the Republican attack on Obamacare is actually decreasing out-of-pocket costs for people. I'm not sure what kind of bizarre universe you're inhabiting but premiums have gone up for most people on the exchanges.
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Jan 5, 2018 04:45
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The Phlegmatist posted:I'm not sure what kind of bizarre universe you're inhabiting but premiums have gone up for most people on the exchanges. From what I understand premiums have gone up thanks to the end of the CSR payments, but because insurance companies are prohibited by law from increasing the cost of the low-income plans those payments were supposed to subsidize, they instead increased the price of the benchmark silver plans and, since federal subsidies are based on the prices of those plans, the out-of-pocket costs for consumers of other plans decreased thanks to greater federal subsidies. Is that not the case.
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Jan 5, 2018 04:57
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VitalSigns posted:From what I understand premiums have gone up thanks to the end of the CSR payments, but because insurance companies are prohibited by law from increasing the cost of the low-income plans those payments were supposed to subsidize, they instead increased the price of the benchmark silver plans and, since federal subsidies are based on the prices of those plans, the out-of-pocket costs for consumers of other plans decreased thanks to greater federal subsidies. This entire statement should have ended with VitalSigns taking a bow and saying, "The Aristocrats." My brain hurts at how stupid we are as a country.
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Jan 5, 2018 06:37
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The Aristocrats!quote:How consumers themselves will be affected by these premium increases, if at all, will depend in some cases on the approach taken by insurers (sometimes at the direction of state regulators). VitalSigns fucked around with this message at 08:27 on Jan 5, 2018 |
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Jan 5, 2018 08:25
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So is the mandate gone for 2018?
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Jan 5, 2018 13:46
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^^ nope, it's gone in 2019VitalSigns posted:Is that not the case. I just looked and the premium costs of our retained members on the exchanges are up 17% on average. In some cases yeah, the increased APTCs made bronze plans free or made gold plans slightly cheaper than silver plans but there's a whole lot of variation depending on where your income level is and what insurers decided to do.
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Jan 5, 2018 18:27
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The Phlegmatist posted:I'm not sure what kind of bizarre universe you're inhabiting but premiums have gone up for most people on the exchanges. https://www.apnews.com/9fc1b9c7854e499c837718a636fde988 Bronze plans have gotten dramatically cheaper after subsidy in many cases, and free in a decent (1500) number of counties.
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Jan 5, 2018 18:31
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Bronze plans are also functionally worthless for people receiving enough APTCs so that they're free though. Like when your deductible is about 60-70% of what you make in a year before taxes then that's not exactly good insurance. It makes more financial sense to stick with low-deductible CSR plans even if you have to pay higher premiums.
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Jan 5, 2018 18:36
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The Phlegmatist posted:Bronze plans are also functionally worthless for people receiving enough APTCs so that they're free though. I thought cheap plan deductibles were up to 5-6k. Considering you have to make over 16k or so to participate in the exchange subsidies, isn't that like 30% of income at most?
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Jan 6, 2018 01:16
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PerniciousKnid posted:I thought cheap plan deductibles were up to 5-6k. Considering you have to make over 16k or so to participate in the exchange subsidies, isn't that like 30% of income at most? For 2018, can be as high as $7,350 for an individual and $14,700 for a family.
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Jan 6, 2018 01:25
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Isn't there benefit to having insurance at all, even if you can't pay the deductible because you'll get better access to care with insurance?
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Jan 6, 2018 03:48
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Twerk from Home posted:Isn't there benefit to having insurance at all, even if you can't pay the deductible because you'll get better access to care with insurance? This is a good question. The bill per procedure might be lower on paper but I’m not sure how that changes if the hospital makes on the fly uninsured discounts. Something else: if you walk into a ER needing a heart transplant and you’re uninsured, you’re not getting it. If you have a garbage health insurance plan I don’t think the hospitals can deny care in that case. The insurance company will be getting hosed of course. Virtue fucked around with this message at 04:46 on Jan 6, 2018 |
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Jan 6, 2018 04:38
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Virtue posted:This is a good question. The bill per procedure might be lower on paper but I’m not sure how that changes if the hospital makes on the fly uninsured discounts. Even with a garbage plan it has to comply with ACA so the out of pocket costs might be substantial for the insured but the hospital will still get a huge chunk of the bill paid for by the insurance company. The patient also will likely have a substantially lower out of pocket bill even compared to lower deductible pre aca plans thst had really lovely coverage and lifetime maximums (20% doesn't sound too bad for your half if the total bill isn't half a mill or whatever).
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Jan 6, 2018 04:49
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Raldikuk posted:Even with a garbage plan it has to comply with ACA so the out of pocket costs might be substantial for the insured but the hospital will still get a huge chunk of the bill paid for by the insurance company. The patient also will likely have a substantially lower out of pocket bill even compared to lower deductible pre aca plans thst had really lovely coverage and lifetime maximums (20% doesn't sound too bad for your half if the total bill isn't half a mill or whatever). I mean substantial is relative. Sure 17.5k is bad but nowhere near the million+ it would cost with no insurance. Thanks Obama.
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Jan 6, 2018 05:50
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