I have to do this again? Obamacare questions, anyone?

[RobAnybody]

I've ventured into this territory before, but I've seen it come up in threads again, so here: I've talked about the $716 billion in Medicare cuts, & even opened a "Ask a health insurance company employee" thread. I'm definitely saying don't bump either one, but rather ask your questions here.

But I've seen the same misconceptions come up, despite those threads, so ask me your questions. I work at a health insurance company. Have at me.

I've seen, in several recent threads, both the "government takeover of health insurance" silliness & the "health insurance companies want to drive up prices" silliness, so I want to combat both. Health insurance companies got a huge boon from Obamacare. Everyone has to buy our product? OMG, throw me in the briar patch why don't you?

The government took over health care? News to me. Us private companies are still operating. No Private Option to compete with. No Universal Health Care. It's all good for private companies. But, we want to keep costs down! Why? We pay for them. Duh. If you have a $50,000 heart attack, & "only" pay a $2000 deductible, we'd like to keep that cost down to $40,000, so we only pay $38,000 instead of $48,000. Should be obvious, but apparently it's not.

You're both wrong, basically, both sides. But I see both sides still complaining about stuff that didn't happen. At best, I hope I can explain why we're not evil.

 

[ace99]

What kind of deal do you lot have with universities that allows colleges to provide students with some sort of health coverage? Who's profiting from it, and who's getting ripped off?

Edit: Obligatory calling you scum.

 

[RobAnybody]

What kind of deal do you lot have with universities that allows colleges to provide students with some sort of health coverage? Who's profiting from it, and who's getting ripped off?

No deal any different than any other "company", really, & oftentimes the universities get much better rates (due to a younger, healthier population) than a similar "company" would get.

Also, if they have a hospital on campus, like for example UNC-CH has in the UNC Hospital, my alma mater, so I'm obviously not disparaging them, or Duke Hospital, which is evil, as are all things Duke, so I'm obviously disparaging them, but still, we give a discount because if a group, like students, are willing to accept a very limited network, where we know almost exactly what it will cost us, it costs us less. So we're willing to pass that savings on to the "customers", which I put in quotations because generally their parents are the ones paying for it.

It's kind of, kind of, kind of a win-win, mainly because they are willing to limit their choice in hospitals, & therefore we kind of know what their costs will be. As opposed to "regular" customers who could go to any of 120 hospitals (in our state) where we have widely varying costs.

I hope I answered your question. I don't feel anyone is getting ripped off, though, so of course feel free to ask for more details.

EDIT: scum accepted; comes with the territory

 

[Dreadnought]

Is this thread addressed to anyone in particular?

Because, quite frankly, my opposition to Obamacare has little to do with the status of health insurance companies, but you make it sound like that's the principle objective that most people have.

 

[Skwink]

Once Obamacare startsn where do i turn my freedom into?

 

[Thedrin]

I'm a European.

I got sick while on holiday in Thailand a couple of years ago and had to spend 2 nights in hospital. My health insurance covered the costs. The insurance company then informed me that I would no longer be covered for the specific complaint that sent me to hospital saying that it was now a pre existing condition. I am still covered for everything else.

I don't have an education in medicine but I have worked for an insurance company (not the health insurance division) and I have some actuary education. I think that the change my insurance company made to my policy was fair. From now on I'll be a bit more discerning about who I let cook fish for me. It shouldn't be too big a problem.

Why are/were pre existing conditions a big issue in the US?

 

[RobAnybody]

Once Obamacare startsn where do i turn my freedom into?

We will be sending vans around where you can turn in your freedom. You will be given a sticker with a smiley face in exchange.

Why are/were pre existing conditions a big issue in the US?

Mainly that you know someone with a pre-existing condition is going to cost more, so no one company could start accepting people with them without everyone accepting them. Otherwise, that one company's costs go way up while their competition stays the same. So it costs more for the healthy people at that company & they start going elsewhere. Which drives costs at that one company up even more, to the point where they eventually *only* have people with pre-existing conditions & can't afford to stay in business.

Basically it was something that had to apply to everyone before it could apply to anyone.

 

[hobbsyoyo]

Is this thread addressed to anyone in particular?

Because, quite frankly, my opposition to Obamacare has little to do with the status of health insurance companies, but you make it sound like that's the principle objective that most people have.

I am pretty sure this was intended as a Q & A about the policy itself (i.e. 'when do the exchanges start', 'how much of a subsidy do I get if I make $xx') and not so much a political or justification thread.
________________________

My question: is there any talk or possibility of the law being changed to include tricare? I am almost 26 so it's a moot point, but the part of the law allowing college students to stay on their parents health insurance to age 26 didn't apply to Tricare (military insurance) and I got booted off at 21.

 

[Thedrin]

We will be sending vans around where you can turn in your freedom. You will be given a sticker with a smiley face in exchange.


Mainly that you know someone with a pre-existing condition is going to cost more, so no one company could start accepting people with them without everyone accepting them. Otherwise, that one company's costs go way up while their competition stays the same. So it costs more for the healthy people at that company & they start going elsewhere. Which drives costs at that one company up even more, to the point where they eventually *only* have people with pre-existing conditions & can't afford to stay in business.

Basically it was something that had to apply to everyone before it could apply to anyone.

Assume Andy and Brian try to get an insurance policy. They are identical except that Andy has a preexisting condition. What you're saying implies either
a) US actuaries assume Andy and Brian are equally likely to run up medical bills, or
b) the actuaries know that Andy is a bigger risk but charge him the same amount as Brian.

What am I missing here?

Edit: if this is too far off topic let me know.

 

[RobAnybody]

My question: is there any talk or possibility of the law being changed to include tricare? I am almost 26 so it's a moot point, but the part of the law allowing college students to stay on their parents health insurance to age 26 didn't apply to Tricare (military insurance) and I got booted off at 21.

Not as part of Obamacare, no, it's not being considered. Mainly because I don't think any major changes of any sort could happen. Nothing could get passed, particularly an expansion of the law, even for military families.

Did you look into the Tricare Young Adult program? It's basically the same thing - coverage up to age 26 for about the same cost as the difference between an Employee Only policy & an Employee + Child policy.

Assume Andy and Brian try to get an insurance policy. They are identical except that Andy has a preexisting condition. What you're saying implies either
a) US actuaries assume Andy and Brian are equally likely to run up medical bills, or
b) the actuaries know that Andy is a bigger risk but charge him the same amount as Brian.

What am I missing here?

You're not really missing anything, although the answer is "b" in this case. Before Obamacare, the actuaries know Andy is a bigger risk & would either charge him a LOT more, or would choose not to cover him at all. Under Obamacare, the actuaries still know he's a bigger risk, but have to charge Andy & Brian the same.

Now, that does mean that Brian is likely to pay a slightly higher rate than he would have before Obamacare, because Andy's claims have to get paid for somehow, but before, Andy would just be screwed, basically. And if any insurance company had chosen to cover pre-existing conditions before Obamacare, they'd have probably lost Brian as a customer to a company that didn't cover them.

 

[Thedrin]

You're not really missing anything, although the answer is "b" in this case. Before Obamacare, the actuaries know Andy is a bigger risk & would either charge him a LOT more, or would choose not to cover him at all. Under Obamacare, the actuaries still know he's a bigger risk, but have to charge Andy & Brian the same.

Now, that does mean that Brian is likely to pay a slightly higher rate than he would have before Obamacare, because Andy's claims have to get paid for somehow, but before, Andy would just be screwed, basically. And if any insurance company had chosen to cover pre-existing conditions before Obamacare, they'd have probably lost Brian as a customer to a company that didn't cover them.

We've got a law coming in in this country on December 21st which says that insurance companies can no longer "discriminate" based on gender, e.g. car insurance is typically cheaper for women since women are less likely to make a claim on their car insurance. Women will now be subsidising the car insurance and life assurance premiums of men who will be subsidising the health insurance premiums of women.

What I'm reading here is that the problem with healthcare in the US is not with the insurance companies but with the cost of healthcare, and that Obamacare (or the aspects of it referenced here) does not address these issues but forces the excessive costs to be spread across all health insurance policy holders.

For the first time, I'm beginning to think that Obamacare may be a bad thing.

 

[peter grimes]

For now and the next calendar year my wife (and expected kiddo) will be on her insurance. But since she won't be working in 2013, we'll almost certainly go back onto my union's insurance for 2014.

Her insurance has a lifetime cap on certain things - for example, my elbow injury. I have something like 50 physical therapy visits for that one problem for life.

Do you know if lifetime caps will be removed from plans under the ACA?

Also, if I go *back* onto my wife's insurance in 2015, would my elbow injury then be considered a pre-existing condition? Or would the lifetime cap reset to 0?

 

[hobbsyoyo]

For now and the next calendar year my wife (and expected kiddo) will be on her insurance. But since she won't be working in 2013, we'll almost certainly go back onto my union's insurance for 2014.

Her insurance has a lifetime cap on certain things - for example, my elbow injury. I have something like 50 physical therapy visits for that one problem for life.

Do you know if lifetime caps will be removed from plans under the ACA?

Also, if I go *back* onto my wife's insurance in 2015, would my elbow injury then be considered a pre-existing condition? Or would the lifetime cap reset to 0?

Lifetime caps are out. As are pre-existing conditions. You'll be fine, thanks to Obamacare.

 

[Mark1031]

What is the is combined overhead and profit margin for a typical US insurance company for health insurance. i.e. total $$ paid to company- total $$ paid for medical care=?%. How does this compare to other countries and to US public medical care i.e. veterans, Medicare?

 

[kochman]

Lifetime caps are out. As are pre-existing conditions. You'll be fine, thanks to Obamacare.

Denial for pre-existing is gone... a good aspect of Obamacare for sure.
However, premiums will go up, understandably, to pay for the forecasted increase in expenses.

 

[illram]

How will insurance companies fiddle with their administrative costs to lower the amount they have to pay back to customers via the admin/costs ratio that is a part of Obamacare? Or in your opinion is this too hard to game, and this will actually help reduce costs?

Can you expand on why you think Insurance companies will be able to drive down costs? Do you think this will be done in a way that winds up making healthcare and health insurance more affordable?

I don't buy the idea that insurance companies will actively try to keep costs down, at least not in the way they need to be kept down and not in a way that will lead to lower costs for the consumer buying health insurance. Denying evidence based care or making it intentionally difficult or putting up roadblocks is not cost saving. To me this was one of the big failures of Obamacare.

 

[galdre]

Insurance companies don't care at all if costs are kept down because they can still deny care (and therefore not pay the high costs at all)

IMO privante insurance companies should be completely gotten rid of. No part of the health care system should be profit based.

 

[hobbsyoyo]

Denial for pre-existing is gone... a good aspect of Obamacare for sure.
However, premiums will go up, understandably, to pay for the forecasted increase in expenses.

Not necessarily as more unisured, healthy young people enter the market and offset the elderly and sickly.

 

[galdre]

Not necessarily as more unisured, healthy young people enter the market and offset the elderly and sickly.

rates are already going up and will keep going up. The insurance companies now have a captive audience so there's no reason for them to not raise their rates.

 

[ace99]

Ideally I think the idea behind the state insurance exchanges are supposed to off-set that but that only works if states actually establish effective insurance exchanges.

Obama should give the state an ultimatum, establish it or else I implement price control.