Obamacare and T1 Pumping

Ok....not a big fan of government intervention in ANYTHING, but I am my son's biggest fan so I am trying to get a feel for a couple of things as it relates to the Affordable Healthcare Act.

I am currently covered by my employer's very good policy. So is my 20 year old son form the next five years. Out of curiosity I tried to get on the Marketplace and do some "what if"scenarios for my son, as if he was 26 and needed insurance. I didn't want to register him as he is covered and I didn't want to "start something" but surfed around the website.

I get it...you pick a plan level, they give you the premium and so forth. While I could see the different companies in Florida that offered the different plans, I could NOT see things like deductibles, and specifically, HOW THEY ARE COVERING PUMPS and PUMP SUPPLIES.

Does anyone put have a Marketplace / Exchange experience yet they could share? I have not had private insurance EVER, alway through employer.

Thanks

 

You are not really going to be able to find out about marketplace experiences, until the first set of previously uninsured type 1 diabetic pumpers order pump supplies. That will be after January 2014, obviously.

As for the private insurance--not employer-sponsored, the companies are required to follow Medicare guidelines at a minimum for everything, including test strips and insulin pump supplies.

Getting a CGM with the Affordable Care Act might be a mixed bag. At least that is what I would be expecting.

 

We have BCBS of AZ right now but we received a letter saying they are dropping our plan. So we are insured now but have to use the marketplace to get new insurance. (We are self employed)

The whole thing I think is very confusing. I have been trying to look at all the different aspects of what's covered but I cant seem to find a lot of real detail. The main thing we settled on for our deciding factor is that our endo is in our plan (besides what we can afford!). My son really loves his doctor and we don't want to lose him.
We are also hoping that maybe with our new insurance the pump will be something more affordable to us. But like I said I have had a really hard time getting any details on what exactly is covered. I have spent so much time looking at the darn computer screen trying to figure it all out that it makes my head spin.

 

I'm probably going to get slammed for this, but here goes anyway...my bigger question is what happens to our kids with pre existing conditions when this hold thing implodes and we are back to square 1. So far from what I am seeing everyone's rates have either gone sky high OR they do not qualify. In order for this whole thing to work, healthy folks must sign up, and so far not many have.

My huge concern is if I were to have my son sign up, will he be eligible to go back on my plan if the system doesn't work? I'm not personally willing to risk it. Not that I could find out anyway, the website totally failed for me...

 

In Colorado, I've been able to compare plans and how they treat DME in the individual market. We are self employed and so have always carried our own insurance. I'm so thankful that we can now switch plans, put our daughter on a better one that covers more. The new plan for her comes out almost the same in the long run...higher premium but lower out of pocket! Colorado has it's own website, however!

 

Actual cost

Well, for my sons sake, I hope something gets worked out in the next five yrs. His actual monthly cost, right now, if he were to pay cash would be approximately ...

12 pods $480
3 insulin 300
120 strips $120
1/6 of office visit $30

930... Let's call it a grand.....12k per yr vs a premium of $4200 plus whatever the company's and deductibles are.

(Florida's most expensive (gold) marketplace plan for someone under 50 is approx 350 and cheapest gold plan around 280).

Now....if that actually covered 90%.. Maybe not so bad, but I have no idea what is and is not covered nor the deductables.

 

Well, my actual cost OOP this month, with VERY good insurance and with all deductibles met, was $610. Thats 20% of his new pump (200 for the next year, so it's not that I am done), my copay on his prescriptions and Dex supplies, plus a $50 office visit. One month only. And they say that pre existing conditions are why costs are higher. I call foul on that, WE are paying the costs of pre existing conditions already.

 

The excuse of pre-existing conditions is pretty low on any intelligent assessment of why medical costs and insurance costs have been too high.

If the ACA doesn't succeed we'll be back to the same rubbish system we have at present. And if it doesn't work for a lot of folks who truly need medical coverage it will be because so many states opted out of the medicaid expansion. And then there is this aspect of the story which hasn't gotten much attention in the press http://www.npr.org/blogs/health/201...-the-stage-for-the-obamacare-website-meltdown

 

One thing I've done is contact the carriers directly and ask about their 2014 plans with regard to DME and specific doctors in their network. It's not too difficult to get through to a real person most of the time. We also have a small business and offer health insurance to our three full time employees paying 100% of their premiums. In looking at the comparable plans (and it's still a bit of apples to oranges...deductibles go down but coinsurance goes up, etc.) it doesn't look like we are going to be paying more for the premiums under the ACA. I'm encouraged! I'm not at all fearful that once I switch dd, the insurance industry is going to go up in flames because of any glitches in the ACA and she'll be left without insurance.

 

How exactly doesn't it work?

I can get a similar plan to what I have now through Aetna on the NY exchange. It is $379 a month. The deductible is $1250 and max OOP (which I would hit in a month) is $6250.

I don't really think the ACA is the answer. But something needs to be done. And this is a start.

 

I do think it's better than nothing.

 

But the ACA specifically caps out of pocket expenses at $6500 for an individual.

 

Sorry for spreading wrong information. I tried to delete the wrong information I posted as much as possible.

I did not know that there was a cap. I am not against equal access to healthcare.

 

Not slamming you but why do you have the view that the "hold thing" will implode? And what does that even mean? You think the new system is going to fail? Maybe try giving it a chance first. I think it is great that people are thinking ahead, but I think people need to take a step back and calm themselves. This is new system and the website doesn't even work properly yet. So that may be why not many people have signed up yet. Also, in the next 5-7 years there may be changes to the existing system as they work the bugs out. Patience is a virtue. :cwds:

 

I haven't found this at all! I can get dd covered on a plan that is comparable to what she has. My husband and I can switch to something with similar premiums to what we have, but better coverage and lower deductibles! Our son in CA will qualify for a stipend due to his income which will be a big help to him!

 

Agreed. And, I think if a person already has partially paid employer health care, then they're already getting the best price, so those people might not be seeing a decrease, but, the ACA isn't really meant for them. The people that will see the benefit are the people who have not been able to get coverage, or people who were buying their own insurance. And, if your income is lowish (and I think it's around under 90k for a family of 4) you get rebates.

If I compare what my husband's civilian employer offers us (they pay no portion of the premium),it's comparable in price/policy to what I can get on the exchange. That said, it's still about 10x more than what we pay for Tricare, (tricare reserve select). So we stick with the govt.

All that said, we've have "romneycare" in Mass for years now, so the whole thing with the exchanges isn't a new thing for us. It's really a non issue in so many ways. If you've got your employer coverage, just stick with it, unless you think you can get something better. Every year, we get a notice saying "you've had coverage for 12 months" and you just indicate that on your taxes. It's just a nothing issue for those of us who always had health insurance.

 

We are the employer, so essentially we buy our own insurance, sort of. Our costs are going up. There is zero benefit. It's very harmful to small business owners.

 

Yes, I meant whole. Simple typo. I don't have confidence the system is sustainable the way it is now. Healthy people need to sign up for the numbers to work, so far they are not. It's more expensive for many (my state, for example). Those with private insurance are staying with that (though my rates have gone up even with that), those without are choosing to stay without and risk the penalty, because if they couldn't afford it before they are unlikely to afford it now (and I've talked to people who are choosing this option).

The math simply does not work. My point was/is what happens to those with pre-existing conditions if this system is overhauled to the point of not including them. I am choosing not to change anything, because I feel my son is safer with his current plan.

 

It does vary by state.

 

This is an article by one of my favorite financial columnists about the potential impact on small business owners.

http://www.newyorker.com/talk/financial/2013/10/14/131014ta_talk_surowiecki