ACA Choices for South Carolina, 2016

[StandingInLeftField]

My former health insurer, Consumer's Choice, was unwilling to continue in the South Carolina Healthcare Marketplace for 2016, so I was faced with the prospect of looking for a new provider. Unfortunately this left me with only two choices, BC/BS (54 plans) or Aetna (two plans.)

My old Silver policy had a premium of $435.00 a month with a $3500.00 deductible and an equal out-of-pocket. The cheapest BC/BS Bronze plan will be $520.00 per month with a deductible of $6,300.00 with an out-of-pocket of $6,850.00. Aetna's cheapest plan (Silver) starts at $890.00 per month...

Granted, prior to the ACA I was not able to purchase ANY insurance, but with this new hike in rates and deducts, I am defacto unable to afford health insurance once again. Because of my and my wife's (currently uninsured) combined income we are not eligible for any subsidies. I'm still not sure I understand the "Affordable" in the "Affordable Care Act."

P.S. - Fuck the Republicans

[cheapdate]

1. We've had the opposite experience here in Middle Tennessee.

Competition among health insurance providers has greatly increased, which has increased consumer choice and lowered prices. My company finally made the decision to abandon our BCBS grandfathered group plan and purchase from the health insurance exchange. I say "finally" because since the exchange got going here in Middle Tennessee, there have been plans offered that are superior in price and benefits to our old plan. Our company leaders wanted to wait for legal challenges to the ACA to work out before making any changes. But this year we made the switch.

It's worked very well here.

[StandingInLeftField]

2. I find that very interesting!

Cheapdate, is Tennessee running it's own exchange or having the Federal gov't. run it for them? My daughter, who lives here in Charleston, would be eligible for subsidies based on her income, but the healthcare.gov representative said because South Carolina opted out of one provision or another (not really clear on that) she would not be able to take advantage of them. However, she was issued an IRS waiver so she does not have to pay the penalty for not having insurance on her income tax.

My wife's ex in Georgia has incredibly low premiums due to his subsidy. I just don't understand what makes South Carolina so different.

It's all so arcane.... Once again, America seeks the lowest common denominator. Manifest Destiny my ass!

[cheapdate]

5. Federal exchange.

The differences are between localities and markets. It's still a system of private health insurance providers. As it happens, a lot of private health insurance companies have decided to compete in our geographical market.

The choice of plans available in our market is remarkable. There are around 25 silver plans and 18 gold plans being offered.

For the past 15 years prior to the ACA, our premiums increased on average 7-1/2% per year, every year. The first year the federal exchange opened, our premium increase was around 2%. It was about the same the next year. But this year we're ditching our old group plan and purchasing from the exchange. My premium will actually be LOWER, even while deductible and out-of-pocket maximums are more favorable.

[karynnj]

7. South Carolina rejected the Medicaid expansion

The ACA legislation as written covered a large group of people by expanding the income range where you could get Medicaid - where the cost would be minimal. The Supreme Court in its first decision said the federal government did not have the right to force the states to do this. Needless to say, many Republican states didn't - even though that hurts their own citizens.

What it does is create a weird situation where people below the original Medicaid threshold, get Medicaid -- people above the expanded Medicaid limit, qualify for subsidies, while the people in between (like your daughter) get nothing.

This is worth advocating for on a state level -- more and more republican states are doing the expansion. The problem is that it is complicated and many people don't realize that it is their own state that is standing in their way and that they could be on Medicaid if the state would simply request it.

Here, blame Judge Roberts (even though he could have shifted to declaring all of the ACA unconstitutional) or blame the Republican state governors and legislators. You can find lots of information by googling Medicaid expansion South Carolina - here's a good one - https://www.healthinsurance.org/south-carolina-medicaid/

[StandingInLeftField]

9. Thanks very much for the link, karynnj.

I appreciate that. Seems like a lot to wade through.

[mountain grammy]

3. Having issues here too. Colorado had a co-op

that went belly up, thanks to Republican fuckery, so we're back to basically un affordable plans.

[StandingInLeftField]

4. I'm so sorry to hear that, mountain grammy!

The only thing I got out of two years of "health insurance" was a free colonoscopy (due to have it done next Friday - if they're going to find something I hope they do before Dec. 31, 2015!) I've got other concerns, but can't afford the deductible.

Oh well, die fast I suppose.

[karynnj]

6. Looking at the Comsumer's Choice statement, they set rates too low to be profitable

Here is their statement:
http://www.cchpsc.org/2016-important-message/

They give the reason for leaving as the fact that they were only going to get 12.6% reimbursement on the amount they paid out over the amount they received as payments.

Looking further, this is a national phenomenon. ACA set up a provision that tried to deal with some companies finding their clients sicker than anticipated and others finding the costs less than expected. A pool of money was created from the extra money earned by the latter -- which would then subsidize those with the higher costs (the former). However - in 2014, the money collected was far below the money needed by the latter. It sounds from their letter, that they are warning people that the company might go under. In essence, Consumer's Choice set the price too low for what they offered. It became economically impossible for them to keep the plans going.

Here is an explanation of the "risk corridor" situation. http://www.modernhealthcare.com/article/20151001/NEWS/151009996

These links are intended to provide background -- as they clearly do not help your personal situation. As to affordable, that always has been a subjective term. It might be worth looking at the BC/BS plan to see what is covered that does not go to the deductible. Annual physicals are included. It it is worth asking them about whether the prices paid on things going against the deductible are discounted. (Our high deductible plan usually reduced the billed amount substantially.)

Not to mention, insurance is most needed when something really bad happens. If you stay relatively healthy, you will not spend anywhere near the deductible. While it also may be true that paying the market rate on everything (ie no insurance) might be less than the sum of the amounts you still had to pay plus the premiums, you would be unprotected against bills that would have destroyed you. if you or your wife had enough medical expenses that you actually reached the entire deductible -- it probably means it was better to have this insurance. It would mean that you had discounted charges that totaled more than the deductible. Without insurance, these bills would still exist and would likely have been maybe 25% more. Note that in this case, you are financially better to have paid the $520 and the deductible rather than the costs that would exist if you were uninsured.

I completely get your shock at seeing the numbers change like this - and it could be that this really does price you out of the market, but I hope that you and your wife do a serious analysis before deciding that. Good luck in working through this -- it has to be a tough thing to deal with.

[StandingInLeftField]

10. Thanks again for the well-thought-out response.

It is rather disappointing paying for what amounts to catastrophic insurance. I'm already in the "bills that would destroy me" mode, after suffering a heart attack that left me with three stents and six days in the ICU, all while uninsured. I can't keep my head above water trying to repay any of that monstrous debt while at the same time trying to pay new higher premiums with double the deductibles and no affordable copays, only 50% co-insurance after the deductibles are met.

[karynnj]

12. Wow - sorry to hear this

I wish I even knew anything to suggest. Your debts really make their use of just income to determine subsidies unfair. Good luck with everything.

[magical thyme]

8. my choice was easier to make last year. I made slightly too much to qualify for

subsidies. Working p/t plus per diem left my income variable, so impossible to predict. Buying insurance through the p/t job would have left me in the red, with zip to spend on any actual healthcare. So I opted for the penalty.

This year is tougher because I don't know what is cheaper; the penalty or shit insurance that gives me no coverage. I'm in Maine, so no Medicaid expansion.

I've just made my first foray into the Medicaid site to see if my social security income will put me above the level of qualifying for Medicaid in a state w/o expansion. Of course, god fucking forbid they should simply have a table that makes it clear: single adult >this income = no Medicaid.

Instead page after page of goblety-gook that doesn't answer my simple fucking question. I finally find the fucking table of what I *think* is monthly income that qualifies for Medicaid, and when I get to single adult, there is a reference to a bunch of goblety-gook with no fucking answer.

Words cannot express how much I fucking hate and resent this fucking extra tax, not to mention the waste of my time trying to minimize it, that provides me zero benefit unless I get sick enough to die and leaves me no money to treat minor things until I'm sick enough to die, in which case, frankly, I'd rather fucking die anyway.

Guess I'll look for a phone # to call and find out one way or the other whether or not I qualify for Medicaid so I can apply for the fucking waiver to avoid the fucking penalty. But I really don't look forward to having to spend time talking to people unless absolutely necessary. I feel zero loneliness -- still trying to detox from the toxic assholes at the last 2 fucking miserable jobs.

[StandingInLeftField]

11. Right there with you.

I've got 9 years until Medicare (if it - and I - survives that long.) That single-wide on the 1/4 acre is looking more and more likely.