Obamacare marketplace premiums in Florida lower than expected

[SaintAugustine]

Yikes! Four years ago at the company I worked for the family coverage was over $1000 a month. And this was only the employee premium, 20-30% of the total premium.

What? $3-5k/month? What the heck kind of plan did your company have? I work for a small company (that pays 100% of our premiums, and the total they pay is nowhere near that. We have a Blue Shield HMO plan with $45 co-pays, and I think they said the premium for my family is ~$1350/month. Maybe your company wasn’t paying as much for their portion as you think.

We are looking at the exchange versus our current provider right now, and it doesn’t look like premiums will change much with the exchange…might be a little bit lower. We are still checking it out.

 

[SamH]

But let’s at least talk for a minute about “preventive care”. People on Medicaid can receive that right now, for free. However, because reimbursement under both Medicaid and Medicare for “well care” (which is what “preventive care” is) has been increased at the expense of “chronic care”, it has resulted already in patient dumping for persons with chronic conditions. It may also be observed that a recent study has indicated that “well care” or “preventive care” does not improve outcomes.

.

And we all know why preventive care doesn’t work. The two biggest factors to a generally healthy life in the US are healthy body weight and daily excercise. Americans are told this by their doctors, the government, their friends and even their enemies. Yet the rate of obesity goes up every year along with heart disease and stroke, high blood pressure, diabetes, cancer and asthma. Seeing a doctor more often doesn’t cure any of those things unless the patient acts on his directions.

 

[SamH]

Care is not only about numbers of doctors or hospitals. Care is primarily about medical attention available to people. Right now many of the clinics in my area would welcome an infusion of patients - to be precise: paying patients - even at Medicare rates. It would decrease the pressure of non-paying patients on area ERs and possibly even on (name removed by moderator)atient facilities.
.

Are you sure about that? Doctors in my area refuse to take medicare and medicaid patients. Our foster children (medicaid) were only accepted by our family physician because our personal relationship. Many “mini-med” clinics flat refuse to provide services unless we pay cash. We were told by the state that we should take them to the ER because they couldn’t refuse service there.

 

[SaintAugustine]

Yikes! Four years ago at the company I worked for the family coverage was over $1000 a month. And this was only the employee premium, 20-30% of the total premium.

What? $3-5k/month? What the heck kind of plan did your company have? I work for a small company (that pays 100% of our premiums, and the total they pay is nowhere near that. We have a Blue Shield HMO plan with $45 co-pays, and I think they said the premium for my family is ~$1350/month. Maybe your company wasn’t paying as much for their portion as you think.

We are looking at the exchange versus our current provider right now, and it doesn’t look like premiums will change much with the exchange…might be a little bit lower. We are still checking it out.

 

[SamH]

What? $3-5k/month? What the heck kind of plan did your company have? I work for a small company (that pays 100% of our premiums, and the total they pay is nowhere near that. We have a Blue Shield HMO plan with $45 co-pays, and I think they said the premium for my family is ~$1350/month. Maybe your company wasn’t paying as much for their portion as you think.

We are looking at the exchange versus our current provider right now, and it doesn’t look like premiums will change much with the exchange…might be a little bit lower. We are still checking it out.

Agreed. Our family plan is $956 (total) a month but with some fairly hefty deductables - about what you see on the “Silver” plan. If you have a chronic illness you can’t afford to be on the “Bronze” plan.

 

[Ridgerunner]

Ridgerunner;11240323:

Care is not only about numbers of doctors or hospitals. Care is primarily about medical attention available to people. Right now many of the clinics in my area would welcome an infusion of patients - to be precise: paying

patients - even at Medicare rates. It would decrease the pressure of non-paying patients on area ERs and possibly even on (name removed by moderator)atient facilities.

I don’t know in what area you live, so I can’t comment on your assertion that there is more medical capacity where you live than there are patients to take care of. Seems like poor planning on their part, and something they could fix by downscaling. But whatever.

Care really isn’t “primarily about medical attention available to people”. It’s primarily about providing quality care within a reasonable time frame, with particular attention to those conditions most in need of treatment. By reducing the cost of simply “going to the doctor” generally, for some people, while increasing it for others, does not accomplish any of that.

I can tell you have not read many medical charts. I have. People on Medicaid are very big ER users, and most of the time for things a person could simply go to a primary care physician to deal with, or to cure by “tincture of time”. Why? Because it’s free. There is an inverse relationship between the cost to an individual and his tendency to overutilization.

In my particular area, where the cost of living is low, providers are happy to take Medicare rate, and do. However, if it goes below Medicaid rate, which the chief actuary for Medicare says it will due to Obamacare Medicare cuts, that will adversely affect the elderly.

 

[Ridgerunner]

one

study? For the patient, prevention is always better than cure, unless the prevention is not properly implemented.

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I don’t know that doctors have anything to say about it. Most providers are now employees of big complexes that determine the parameters of the patients doctors will and won’t see. And yes, those organizations very much do pay attention to what pays most for the doctor’s time and what doesn’t.

 

[kmcarl56]

Before you take a stance for or against Obamacare, know the facts! Here is a very indepth look at what Obamacare will actually do for healthcare in America, and what your tax dollars are actually paying for.

obamacarefacts.com/obamacare-facts.php

Those on Medicare have paid dearly for their benefits all the years they have worked. That’s 41 years for me. and I am a disabled 57 year old woman who lives on $1,294.00 per month (that’s $8.09/hr, or well below poverty line). It is not our fault that the federal government has misused those funds to further their own private endeavors.

Those on Medicaid, which is Socialized Medicine, have no alternative because private insurance rates are so exorbitant. The qualification standards are sometimes pennies higher than a person makes, so they are denied. They end up not going to the doctor at all, so they are out of work and therefore do not pay taxes.

Small business owners cannot offer insurance to their employees because insurance rates are so high. I was CFO of several small businesses, but I made sure my employees were covered. It took a big chunk out of our profits, but if our employees were not at work producing, we weren’t making any money at all.

What Obamacare actually does is offer insurance to all people for reasonable rates. It gives them insurance for pre-existing conditions. It gives them preventive care so that they will not become ill and unable to work.

Just know the facts. At present, the #1 Gross National Product in America is Healthcare! …which includes insurance company profits.

Just know the facts. At present, the minimum wage puts people in poverty. At present, people are receiving more in unemployment benefits than they can make working at their current skill level.

Just know the facts. Insurance rates will decline because more people will be covered and able to afford it. Doctors will have to charge more reasonable rates. Laboratories and other medical services will be there for all so that serious health issues can be discovered before they become life-threatening.

Just know the facts. The more people who are working strengthens the economy. The more people who are working keeps hope and morale up for the American people.

Just know the facts. More people will be needed to work in the insurance and healthcare industries to heal those who are sick, both physically and financially.

Do you want to change these things? Do you want to tell those in Washington that WE are paying their salaries and their health insurance, and we can surely cut them off by not voting for them again? Do you want to tell those in Washington that they are there to represent us for the overall good of all people, not just those who are funding their campaigns. Do you want to tell insurance companies that they have to cover you at cheaper rates because we say so? Do you want to tell doctors to stop charging $100-$500 per visit?

Do you want to tell Mr. Boehner that he works for us, we the people, the United States Citizens’ House of Representatives, not just for the (republican) government? If so, then write to him, and tell him so! But first, I urge you to know the facts!

speaker.gov/contact/

Pray for the healing of this nation.
Pray for the health and welfare of all people equally.
Pray that we can take care of our children so that they can grow up healthy and strong.
Pray that we can take care of our elderly so that they can teach our young.
Pray for pregnant women so that they can have proper care and deliver healthy babies.
Pray for the men and women who are working so diligently to give us the healthcare that we, as the most powerful and wealthiest nations on earth, deserve.

May God bless you all in all that you do and say today and for the rest of your lives, and may God bless you all with good health.

 

[Ridgerunner]

And we all know why preventive care doesn’t work. The two biggest factors to a generally healthy life in the US are healthy body weight and daily excercise. Americans are told this by their doctors, the government, their friends and even their enemies. Yet the rate of obesity goes up every year along with heart disease and stroke, high blood pressure, diabetes, cancer and asthma. Seeing a doctor more often doesn’t cure any of those things unless the patient acts on his directions.

Presently, there is a series of questions and recommendations providers are additionally rewarded by the government for asking or making. I don’t remember them all, but they definitely include weight loss recommendations, dietary advice, exercise recommendations and other “lifestyle” things. They are directed as well to comment on the chart whether the patient is or is not compliant with the last recommendations. So, if Suzy is told to lose 30 lb, but doesn’t, that is entered on the data base as well. She’s “noncompliant”. Some judgments, like “properly taking the meds” are subjective, based on expected versus actual outcome. If you are prescribed the “right” med for hypertension but your blood pressure is repeatedly too high, the doctor or NP may list you as “noncompliant”, because “evidence based medicine” says it shouldn’t be.

In 2016, that reporting is mandatory. Providers will be fined if they don’t do it. If a person is “noncompliant” over a period of time, that patient automatically becomes “chronic”. He will then become a less remunerative patient for the medical complex and stands a good chance of being dumped.

 

[_Abyssinia]

Barack Obama said today

They said this would be disaster in terms of jobs – [but] there’s no widespread evidence the ACA is hurting jobs ____

edition.cnn.com/TRANSCRIPTS/1309/26/cnr.05.html

Bee County judge: part-time workers’ hours will be reduced because of new federal health care laws

Businesses claim Obamacare has forced them to cut employee hours

Aurora CEO cites Obamacare as partial cause of job cutbacks

Medical giant Stryker cuts 1,170 jobs, citing ObamaCare

Latest Obamacare casualty: 100 workers at Smith & Nephew

Examiner Editorial: Companies cut hours and jobs to dodge Obamacare

 

[Ridgerunner]

Before you take a stance for or against Obamacare, know the facts! Here is a very indepth look at what Obamacare will actually do for healthcare in America, and what your tax dollars are actually paying for.

obamacarefacts.com/obamacare-facts.php

Those on Medicare have paid dearly for their benefits all the years they have worked. That’s 41 years for me. and I am a disabled 57 year old woman who lives on $1,294.00 per month (that’s $8.09/hr, or well below poverty line). It is not our fault that the federal government has misused those funds to further their own private endeavors.

Those on Medicaid, which is Socialized Medicine, have no alternative because private insurance rates are so exorbitant. The qualification standards are sometimes pennies higher than a person makes, so they are denied. They end up not going to the doctor at all, so they are out of work and therefore do not pay taxes.

Small business owners cannot offer insurance to their employees because insurance rates are so high. I was CFO of several small businesses, but I made sure my employees were covered. It took a big chunk out of our profits, but if our employees were not at work producing, we weren’t making any money at all.

What Obamacare actually does is offer insurance to all people for reasonable rates. It gives them insurance for pre-existing conditions. It gives them preventive care so that they will not become ill and unable to work.

Just know the facts. At present, the #1 Gross National Product in America is Healthcare! …which includes insurance company profits.

Just know the facts. At present, the minimum wage puts people in poverty. At present, people are receiving more in unemployment benefits than they can make working at their current skill level.

Just know the facts. Insurance rates will decline because more people will be covered and able to afford it. Doctors will have to charge more reasonable rates. Laboratories and other medical services will be there for all so that serious health issues can be discovered before they become life-threatening.

Just know the facts. The more people who are working strengthens the economy. The more people who are working keeps hope and morale up for the American people.

Just know the facts. More people will be needed to work in the insurance and healthcare industries to heal those who are sick, both physically and financially.

Do you want to change these things? Do you want to tell those in Washington that WE are paying their salaries and their health insurance, and we can surely cut them off by not voting for them again? Do you want to tell those in Washington that they are there to represent us for the overall good of all people, not just those who are funding their campaigns. Do you want to tell insurance companies that they have to cover you at cheaper rates because we say so? Do you want to tell doctors to stop charging $100-$500 per visit?

:

If these were, indeed “facts”, you might have an argument. But they’re not. They’re all just conclusions without your having given the slightest foundation for them.

I might add that besides being without any factual basis at all, many of them are just plain wrong. I’ll give just one example. You assert that Obamacare will make insurance less expensive for all. Not even Obama claims that anymore. The CBO says it’s not so. It will be less expensive for some but much more expensive for others. It’s an income redistribution scheme, first and foremost.

Did you know, for example, that the “discretionary income” of a person making $100,000 will very nearly be the same as a person making $40,000 because of Obamacare. The reason is that the person making the lower amount will be heavily subsidized while the person making the higher income will face much higher premiums because of the mandates. And that’s without even considering that the person making $40,000 might be receiving some other kind of government benefit while the one making $100,000 definitely won’t be.

Now, if a person believes in leveling incomes (which obama apparently does except for his super-wealthy friends) that’s a good thing. If one does not believe in equalizing outcomes regardless of one’s efforts, then it’s not.

 

[_Abyssinia]

Obamacare State Exchanges May Fund 111,500 Abortions a Year With Your Money

 

[SamH]

In 2016, that reporting is mandatory. Providers will be fined if they don’t do it. If a person is “noncompliant” over a period of time, that patient automatically becomes “chronic”. He will then become a less remunerative patient for the medical complex and stands a good chance of being dumped.

I wonder if they’ll add voting habits to the criteria.

 

[seekerz]

There has been a multitude of sources quoted and linked in this thread addressing premiums. You either haven’t looked at any of it, or just willfully choose to ignore it.

Those are projections. The actual plans and accompanying premiums on the marketplace will only be released on Oct 1st.

 

[seekerz]

And we all know why preventive care doesn’t work. The two biggest factors to a generally healthy life in the US are healthy body weight and daily excercise. Americans are told this by their doctors, the government, their friends and even their enemies. Yet the rate of obesity goes up every year along with heart disease and stroke, high blood pressure, diabetes, cancer and asthma. Seeing a doctor more often doesn’t cure any of those things unless the patient acts on his directions.

Preventive care works - IF it is done right. There are various levels of preventive care. I could have 3 types of chronic disease and STILL benefit from preventive care, as in good control of my blood pressure (to prevent stroke), good control of my blood sugar (to prevent multiple, serious, expensive complications), and good surveillance (to prevent my cancer from returning). Some, if not all, of these ARE included under the preventive coverage provided free of out-of-pocket costs by these plans.

 

[seekerz]

Are you sure about that? Doctors in my area refuse to take medicare and medicaid patients. Our foster children (medicaid) were only accepted by our family physician because our personal relationship. Many “mini-med” clinics flat refuse to provide services unless we pay cash. We were told by the state that we should take them to the ER because they couldn’t refuse service there.

I am positive about that. There are some practices in our area which will not take Medicaid pts, but everybody takes Medicare - and with the large numbers of uninsured, most practices take a few of those too. I’m pretty sure most practices would jump at Medicare level reimbursement from the uninsured, who now are either rejected outright (very few practices here take no uninsured) or accepted at a loss.

 

[seekerz]

seekerz;11240384:

I don’t know in what area you live, so I can’t comment on your assertion that there is more medical capacity where you live than there are patients to take care of. Seems like poor planning on their part, and something they could fix by downscaling. But whatever.

I don’t have stats - it’s just my impression from what I observe and hear. Of course I may be wrong but wouldn’t any business with empty waiting rooms welcome whatever additional reimbursement they could get? My impression is that things took a dip with the economy - rather than it being a function of poor planning. We live in one of the poorest areas in the country.

Care really isn’t “primarily about medical attention available to people”. It’s primarily about providing quality care within a reasonable time frame, with particular attention to those conditions most in need of treatment. By reducing the cost of simply “going to the doctor” generally, for some people, while increasing it for others, does not accomplish any of that.

I’m Texas but the definition of care does not differ here from anywhere else. Here, the ACA doesn’t mean that some will pay more and others less, it means that some will get care that they were not getting AT ALL. Therefore making available a way to pay the doctor does = improving care. Something is greater than zero, unless my math ability fails me.

Blessed are those who can complain about quality. Tons of people in my neck of the woods don’t even bother to seek care until illness is advanced, because of the cost - that includes even some minimum wage workers.

I can tell you have not read many medical charts. I have. People on Medicaid are very big ER users, and most of the time for things a person could simply go to a primary care physician to deal with, or to cure by “tincture of time”. Why? Because it’s free. There is an inverse relationship between the cost to an individual and his tendency to overutilization.

You have no clue what I’ve read but enjoy the guessing game. I have enough basis for my statement - let’s just leave it at that. I am not very familiar with the behavior of Medicaid pts as compared to those who have to pay premiums, but I would surmise that given the fact not all practices accept them, some people are forced to use the ER for primary care. My greater experience is with ‘frequent fliers’ in the ambulatory setting, with underlying mental/behavioral health issues which are not adequately addressed and which manifest as a minor physical ailment several times a month.

In my particular area, where the cost of living is low, providers are happy to take Medicare rate, and do. However, if it goes below Medicaid rate, which the chief actuary for Medicare says it will due to Obamacare Medicare cuts, that will adversely affect the elderly.

Guess it all depends on where you live. Until recently, Medicaid paid some things better than Medicare, but in the last year or two that has changed. Medicare would have to exert itself considerably to go lower than Texas’ Medicaid reimbursement rates.

 

[SamH]

I am positive about that. There are some practices in our area which will not take Medicaid pts, but everybody takes Medicare - and with the large numbers of uninsured, most practices take a few of those too. I’m pretty sure most practices would jump at Medicare level reimbursement from the uninsured, who now are either rejected outright (very few practices here take no uninsured) or accepted at a loss.

I wonder why health care providers refusing Medicare and Medicaid is a national problem except in your little part of the world?

The number of U.S. doctors treating patients enrolled in Medicare is falling, according to a recent story in The Wall Street Journal (subscription required, or published here at South Coast Today). According to the article, the increased number of doctors refusing to treat Medicare patients can be attributed to provider “frustration with [Medicare’s] payment rates and pushback against mounting rules.”

CMS – which has never before released Medicare opt-out figures – reports that 9,539 physicians opted out of the Medicare program in 2012. That is up from 3,700 physicians opting out in 2009. All in all, the number of doctors who opted out of Medicare in 2012 nearly tripled from just three years prior. According to The WSJ, many other doctors who are not opting out of the program are at least limiting the number of Medicare patients that they treat.

Likewise, a study from the American Academy of Family Physicians reports that 81 percent of family doctors accepted new Medicare patients last year, which was down from 83 percent in 2010.

healthcaretechnologyonline.com/doc/doctors-refuse-to-accept-medicare-patients-0001

If you’re on Medicaid and looking for a new doctor, your chances are excellent of finding one … in Wyoming.

In New Jersey, not so much.

About 69 percent of doctors nationally accept new Medicaid patients, but the rate varies widely across the country, according to a study published Monday in the journal Health Affairs.

New Jersey had the nation’s lowest rate at 40 percent, while Wyoming had the highest, at 99 percent, according to a survey last year of doctors by the U.S. Centers for Disease Control and Prevention.

For years, some states have struggled to attract doctors to treat patients enrolled in the state-federal health insurance program for the poor, largely because of their low pay. New Jersey’s reimbursement rate for Medicaid doctors, compared to what Medicare pays, is the lowest in the nation, according to the study.

kaiserhealthnews.org/stories/2012/august/06/third-of-medicaid-doctors-say-no-new-patients.aspx

 

[seekerz]

I wonder why health care providers refusing Medicare and Medicaid is a national problem except in your little part of the world?

You must be mistaken, I never said providers don’t refuse Medicaid. I said that around here everyone tends to accept Medicare.

 

[SamH]

You must be mistaken, I never said providers don’t refuse Medicaid. I said that around here everyone tends to accept Medicare.

And?

What happens to the 90 million people that have a Medicaid card that’s worthless because no one will take it? Think of it, we went from 30 million with no insurance to 90 million with no healthcare - how is that an improvement for the 1/3 the population or the national well being?