Monday, September 30, 2013

ObamaTax Exchange Jitters - Part 1

Over the weekend, co-blogger Patrick sent me the link to an online "database" that purported to have the rates for various QHP's (Qualified Health Plans) as they'll appear on the Exchanges. Only problem was, the "data" was simply a recap of how many plans and carriers would be participating in a given state. But I wasn't all that surprised since I'd just seen this little gem from an agent in the Old Line State:

So tomorrow I’m supposed to be able to start enrolling people in the great and glorious future of health insurance. No doubt figuring that it would be helpful for me to know what plans are available to enroll people in before that date, this past weekend Maryland Health Connection emailed me a handy little quick reference guide to available plans. 876 pages of coverage grids, yay! I’ve been paging through it, and it’s really back to the future time, these are, with 2 exceptions so far*, old fashioned Major Medical (MM) plans.

Let me explain: Traditionally, a MM plan is a simple thing; you have a deductible of whatever, you pay for all your medical treatments until you spend that much, then the insurance kicks in. In recent years, most major carriers have modified MM plans so that some/much/most outpatient treatment was not subject to the deductible, but just required a copay. It works pretty well, if something major happens (i.e. hospitalization, surgery) there’s a deductible to meet but it’s not so bad because the bill’s huge, but in most normal years thing like docs, Rx, ER just require a copay. People are NOT going to be happy going back to the old model. EVERYTHING except preventive care is now subject to the deductible. It could work if the cost came down significantly, back to where it used to be, but we already know it’s going up.

And that’s the other thing. There are no prices attached to these plans. I’m supposed to start enrolling people tomorrow, wonder if I’ll have it by then? Without some idea of costs, I have no way to judge whether these are “good” insurance plans or not. They could be, if they are cheap enough. (Hell if they’re cheap enough, it would be dragging insurance back to what it’s supposed to be instead of being prepaid medical) I’m not holding my breath, however, and I’ll tell you something else: People who have been covered by comprehensive work plans that require little out of pocket from them at the point of service are going to scream bloody murder.

Also along the same everything-old-is-new-again lines, HMOs are back with a vengeance. Pre-approvals and referrals are the new black.

* UHC has managed to retain a smidgeon of outpatient coverage not subject to the deductible, but it’s not even close to what their plans cover now. Also, what I can only call “super insurance” is available; BCBS has one plan where you pay nothing for health care, no deductible, no copay, no coinsurance, nada. Network limited, but your annual out of pocket max is $0. I really, really want to know what that one costs.

Thanks, WD!

Stay tuned for Part 2 - the other shoe drops.
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