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11/12/2013 6:00:00 AM
Under health insurance law, established options best for now

Kim Steele
Miner Staff Reporter


KINGMAN - The state's largest health care insurer for the individual market said Mohave County residents should skip the federal exchange when it comes to purchasing health plans to comply with the Affordable Care Act and buy directly through local brokers or the insurance companies servicing Arizona.

Policies offered online through the federal exchange are centered around Maricopa County, which includes Phoenix, said Jeff Stelnik, senior vice president of sales, strategy and marketing for Blue Cross Blue Shield of Arizona. That means access to local doctors and services may be limited - a fact not readily disclosed on the federal website that lists available policies and allows buyers to sign up for them.

"There are misconceptions out there that people can only go through the website," said Stelnik. "But there are dangers to going directly on the exchange. Some of the plans listed there don't have a robust network throughout the state and are limited outside of Maricopa County. We strongly recommend going through a broker or insurance company that has been in the community for years. Health care is very complex and to buy it through a website is hard, even when the site is working."

President Barack Obama signed the Patient Protection and Affordable Care Act into law March 23, 2010. The program was developed to put comprehensive care within the reach of millions of uninsured or underinsured Americans. More than 48 million Americans don't have any coverage, according to the U.S. Census Bureau.

In Arizona, more than 1 million residents are now eligible to shop for plans on the federal exchange, and about half of those are eligible for federal subsidies. Several major companies provide many of the state's policies - Blue Cross Blue Shield of Arizona, Aetna, Cigna, Health Net, Health Choice, Humana, University of Arizona Health Plan and Meritus.

BCBS of Arizona offers more than a dozen plans across all tiers that range in prices, said Stelnik. It is difficult to compare new rates with existing plans, he said, but premiums will be higher in January for several reasons. First, the new policies are required to include the 10 essential benefits, which limit consumers' choices.

Currently, BCBS offers deductibles ranging from $200 to $10,000, with higher-deductible plans offering fewer services. But those policies with higher deductibles - all $7,500 and $10,000 deductibles, and some $5,000 deductibles - will be cancelled because they don't meet the federal guidelines. Those that remain will cost more because they include more services, he said.

Stelnik cautioned consumers who already have policies to take their time before replacing them with new policies in January. Those purchased before the ACA became law remain in effect indefinitely, while those bought between March 2010 and the end of this year will be grandfathered in through the end of 2014. That can save policyholders significant money, said Stelnik.

Another reason premiums will be higher after January is that younger policyholders 25 to 40 years old will subsidize those 55 years and older. And because there will be no difference in price for males and females, younger males will subsidize females, who generally require more services.

Two additional factors that will raise the cost of premiums are numerous taxes and additional fees that have been added to keep the ACA afloat, said Stelnik. Also, after January, consumers with pre-existing conditions that were formerly excluded from coverage will be able to purchase policies immediately. Those increased costs must be spread around to others, said Stelnik.

"When you add everything up, the concept of premiums going up in price is a true statement," said Stelnik. "This law is so complex, and Blue Cross has taken a leadership role to help our customers find what fits them the best. The ACA has been in place since 2010, and it's the law of the land now, We haven't spent a lot of time thinking of what could have been. Instead, we've been working on how to implement what's here. We're worried about our customers and have gone into listening mode to structure the policies our customers need."

The ACA depends on younger, healthier Americans buying into the program and paying premiums to offset costs for covering older people who need more health care. Those without insurance who do not sign up for a plan face a fine. Federal sliding-scale subsidies kick in for consumers who earn up to 400 percent of the federal poverty level.

Among the new standards in the law are allowing children and dependents to remain on their guardians' insurance plans until their 26th birthday. Also, there is a ban on dropping policyholders if they become sick and there is no longer a price discrimination on the basis of pre-existing conditions or sex.

Insurers will be prohibited from imposing annual or lifetime coverage caps on 10 essential benefits. These are ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.

The law establishes four tiers of coverage: bronze, silver, gold, and platinum. All categories offer the same set of essential health benefits but have differing levels of premiums and out-of-pocket expenses.

Open enrollment on the HealthCare.gov exchange runs from now through March 31, and insurance plans purchased by Dec. 15 will begin coverage on Jan. 1

Policies issued before 2010 are exempted by a grandfather clause from many of the changes to insurance standards.

But the program has been fraught with problems, especially lately with the failure of the website that was set up to enroll people in the new health insurance exchange starting on Oct. 1. Visitors to the website couldn't log in, faced long delays, got constant error messages and had their profiles disappear. The administration says it will have the website running smoothly by Nov. 30.

Also, Obama apologized last week to Americans whose insurance plans are being cancelled by their insurance companies because of the ACA, even though he had promised in previous years that they would be able to keep the plans. Currently, about 12 million Americans buy individual policies on the private market that don't meet the new federal requirements for more comprehensive care.


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Reader Comments

Posted: Wednesday, November 20, 2013
Article comment by: Amaryllis Smith

If OB wanted a legacy other being the worst excuse for a president ever, he should have ok'd the KeyStone pipeline, and worked to reform the atrocious tax law and abolish IRS.

Posted: Sunday, November 17, 2013
Article comment by: too hort

"What good is a useless cheap policy that when you get sick need it drops you, will not pay for serious needs, does it make you feel protected? One has to wonder do these self professed fiscal conservatives have any common sense or just so ideological they are their own worst enemies in life! Or they are insurance sales persons who see the junk policy gravy train ending and they have to work and sell a decent policy now?"

your whole post is a mass of contradictions I think though it's hard to tell.



Posted: Sunday, November 17, 2013
Article comment by: Linda Athens

aa: I have yet, thru this entire trainwreck called obamacare, seen one person say they have a policy that didn't pay.

Take the blonde liberal on Fox news, Kirsten Powers. Big obama lover, hers was cancelled, was not sub-standard. They re-placed it with exactly the same coverages...bigger premium, bigger deductible. She is mad that obama lied.

When will you face the truth. It is now proven fact (from subpoened e-mails by the oversight committee), they knew all these policies would be cancelled and they planned it that way. It even says so right in OBAMACARE but...noone read it except Dr. Betsy McCaughey. And she told us.

It is all designed to re-distribute wealth, go to a single payer, socialist plan that is hated in countries that have it.

Do your homework aa. Single payer is where you will get sub-standard care, wait forever for procedures we now get in days. People will die.

Why do you think Canadians come over the border to American Dr's?

This is all about socialism/communism, big government running our lives? Ever watch the Stossel show on Sat nites? Check it out if you want to see Big Brother in our faces in action.


Posted: Sunday, November 17, 2013
Article comment by: Best Choice: ACA Insurance Marketplace

Don't fall for this nonsense. The insurance plans that are in the exchange are competing against other insurance companies and THAT is where you are going to get your best deal if you need to provide insurance because you have none though an employer.

It's true that SOME insurance companies have "IN NETWORK" and "OUT OF NETWORK" changes, but I have not seen any that actually won't allow you to go see the doctor you want to see. Regardless, that is completely up to the selling insurance company, and that will be shown on the policy.

These corporations are up to their tricks again --- their whole goal is to sell you the policy that will LEAST LIKELY result in them paying on your claim.

And here is the MAIN reason you want an EXCHANGE plan: IF your insurance company DENIES your claim, all of the exchange plans will come with a chance to challenge your insurance company by appealing to a panel of experts. IF those medical experts find that your procedure should have been covered, the insurance company will have no choice.

BUY your policy in the Exchange -- Don't be fooled by trickery!! They DO NOT care about you!


Posted: Sunday, November 17, 2013
Article comment by: J J

"You're right. Subsidies are only available for the junk plans on the Exchanges. It's as if they knew the plans would be junk and needed to give people a reason to buy them...." - that statement is an absolute lie. On the exchange once you are shown you get a subsidy, it shows you your plan amount for EVERY plan, even the most expensive platinum plans, with your subsidy amount and without so you know how much you're saving. I know, we signed up two weeks ago. Only got a $20 subsidy because our income is high. Plans were the same price we paid three or four years ago for similar private insurance.

Posted: Sunday, November 17, 2013
Article comment by: Linda Athens

(delete)

You're right. That's what's considered a junk policy under obamacare - planned that way of course to deliberately get people thrown off.

You're 55 say and your policy doesn't have free birth control pills and maternity care so you are automatically a junk policy...even though at 55 you don't need it.

They explain it away by saying everyone pays taxes for schools even though not everyone has a kid in school. I believe that would be homeowners paying actually. Not exactly the same.

And Just Wondering - having an insurance agency for years, younger people do get nailed on the price due to their higher accident rates so understandable but the rest you sure nailed. We are leaving them one hell of a mess.










since young people do have the most accident


Posted: Sunday, November 17, 2013
Article comment by: Amaryllis Smith

The entire Obamacare debacle will have to be repealed and start from scratch. The legality of his so called "fix" on Thursday is being questioned.
Nancy Pelosi and Harry Reid both need to be put to pasture and all the dim dems who just played follow the leader and passed a bill they Never read should be put out of office.
I believe Obama really underestimated the American People and our strength when pushed to brink!

Yes, it is true ACA requires pre-natal and post-natal to be carried by all. As Mike Huckabee said, "it would be an absolute miracle should he give birth" so why must he carry it?

From age 17-24 I had 5 surgeries and never was in need of pre/post natal care, seems so strange now to realize we were probably paying all those years after for such a thing unnecessarily-we just never considered questioning it
But, I suppose it is required by ACA to pay for all the out of wedlock pregnancies(which were anyway). Remember OB's brain child JULIA, From cradle to grave he could make it all better for her!


Posted: Sunday, November 17, 2013
Article comment by: anonymous anonymous

What good is a useless cheap policy that when you get sick need it drops you, will not pay for serious needs, does it make you feel protected? One has to wonder do these self professed fiscal conservatives have any common sense or just so ideological they are their own worst enemies in life! Or they are insurance sales persons who see the junk policy gravy train ending and they have to work and sell a decent policy now?

Posted: Saturday, November 16, 2013
Article comment by: Linda Athens

Bob Moore said AGAIN Dr. Betsy McCaughey is a shill for the insurance industry.

Here's who she really is. She has a PhD in Constitutional History, Founder and Chairman of Committee to Reduce Infection Deaths (RID), is former Lt Governor of NY.

She has taught at Columbia and Vassar, held academic appointments in health law at the Manhattan and Hudson Institutes, has authored over 300 scholarly articles, written three books including the history of our Constitution. She writes for the Wall Street Journal, NYTimes, Modern Healthcare, New Republic and is featured on ABC Good Morning America,CBS Morning Show, 20/20 among others. Her focus is protection for the elderly, especially concerning getting infections in hospitals.

Shill for the insurance industry isn't in there.

Rush Limbaugh isn't a whacked out drug addict. He's a person, who like millions of other people, once got addicted to prescription pain killers for a bad back...got over it long ago.

And me? You're in MY private life and violating Miner rules. Since you don't even know me, you don't know whether I am thriving or not. You need to back way off of me. You can take that to the bank.


Posted: Saturday, November 16, 2013
Article comment by: V Stokes

"who now have access to healthcare...."

Wait...you mean some people never had access to healthcare? They couldn't walk into an ER or Emergent Care type clinic and be treated? That's amazing....I've never seen a person turned away from a medical facility just due to insurance issues. The nurses, PAs, and doctors don't seem to care at all about insurance.

That's odd...


Posted: Saturday, November 16, 2013
Article comment by: jim harper

I'm seeing BCBS Preferred provider plans for $252 for 40yr old non-smoker on the Healthsherpa web site. non-subsidized. That seems like a pretty fair price. If you want a rock bottom price, its about $200 per month.

If you qualify for the subsidy you will probably have to make two phone calls instead of one. Boo Hoo

I don't have a problem with people who pay the extra 1% in federal taxes and do with out. The Freedom To Be Stupid is a fundamental American right. I can at least quit feeling sorry for those who go bankrupt over their medical bills. .


Posted: Thursday, November 14, 2013
Article comment by: Anson's Nephew

“Good old Dr. Betsy McCaughey…”

Who has proven to be a lying shill for the insurance industry.

“(Source: Rush)”

Sorry, but whacked out drug addicts on the radio can never be considered as a “source!”
”Meanwhile 444,000 new Medicaid enrollees…”

That’s a good thing right? That means there are 444,000 people who now have access to healthcare. Why would you think that’s a bad thing? After all you thrive on government supported healthcare.



Posted: Wednesday, November 13, 2013
Article comment by: abc def

You're right. Subsidies are only available for the junk plans on the Exchanges. It's as if they knew the plans would be junk and needed to give people a reason to buy them....And HONEST people in the insurance industry agree.

Posted: Wednesday, November 13, 2013
Article comment by: Just Wondering

You have to feel sorry for the young people in this country. We screw them over every time. Higher auto insurance because they're a high risk and now we want them to fund our health insurance even though they're considered a low risk. They make lower wages and pay higher taxes. The government keeps pushing back the age limit for Social Security. We make the mess and expect them to clean it up. Know wonder kids have little respect for the older generation, WE HAVEN'T EARNED IT.

Posted: Tuesday, November 12, 2013
Article comment by: biker randy

Don't know if this is true or not but some media are claiming part of the reason you have to pay more is EVERYBODY is being charged partly for the cost of baby births and birth control pills for women only(no matter your age or sex). If this is true it's sheer stupidity for those who need neither coverage in the latter years of their life.

Posted: Tuesday, November 12, 2013
Article comment by: Linda Athens

Kim: 193

Please advise your boss you need a raise for writing this story. I will have to re-read it about ten times to take it all in, In the meantime....."THIS LAW IS SO COMPLEX...." is the operative sentence.

I tried helping someone apply, finally made it to screen four only to be faced with lists of hours it would now be available...otherwise...SHUT DOWN.

First, it is so absolutely ridiculous, it will probably have to be thrown out in it's entirety like Hillarycare was. Good old Dr. Betsy McCaughey who has read obamacare completely was the one who also read Hillarycare when they finally came out of hiding with it. What nixed it was....surprise....no guarantee you could keep your policy and your Dr.

In Hillarycare, Dr's would be told what type Dr they would be and where they would work. Opposite of freedom. (Source: Rush)

Meanwhile 444,000 new Medicaid enrollees, 91 million Americans now out of work (one-third of us), and that is considered a success by obama devotees. And a measly 50,000 signed up on the federal exchange. Good grief, could there be a worse mess than this?


Posted: Tuesday, November 12, 2013
Article comment by: Concerned Observer

I understood that, in order to receive the subsidy for lower income, you had to apply through the government run insurance exchange. I don't think you can get the subsidy, and lower price, buying directly through the insurance provider. Am I wrong about this?

Posted: Tuesday, November 12, 2013
Article comment by: Frank Lee Speaking

How long will it be until leftist obamacare fans show up to claim that your writing this article proves you and KDM are part of some vast conservative conspiracy to sabotoge obamacare?

LOL




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