insurance

Movember: Men's Health Alert

Movember: Men's Health Alert

A few weeks ago, we highlighted October as Breast Cancer Awareness Month, and raised $800 towards research to fight this terrible illness. This month, we turn our attention to the Y-chromosome side:(And watch through to the end for more info on how to help) …

12Dec2014

PresBo lied, Healthcare Died

PresBo lied, Healthcare Died

The right-wingers at CNN have released a video showing - conclusively - that the goal of the ACA ObamaTax was always to destroy the previous system and increase taxes: [Hat Tip: Ace of Spades] …

12Dec2014

Web (in)Security

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<span style="font-family: Verdana,sans-serif;">Yesterday,  I received the following from CoveredCA:</span><b><span style="color: #33cccc; font-family: "Verdana",sans-serif; font-size: 10.5pt;"> </span></b></div>
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<span style="font-size: small;"><b><span style="color: #33cccc; font-family: "Verdana",sans-serif;">New!  iPad Online Application:  Replace "HTTPS" with "HTTP" in URL Address</span></b></span></div>
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<span style="color: #545454; font-family: "Verdana",sans-serif; font-size: small;">If you are using your iPad for enrollment and already have an URL saved to get to the open enrollment online application, you will need to update the URL Hyper Text Transfer Protocol Secure (HTTPS) address by removing the “S” from the “HTTPS” in the URL address so you can access the open enrollment online application. </span></blockquote>
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<span style="font-family: Verdana,sans-serif;"><b>Seriously?</b>   <b>HTTPS is the secure protocol</b> for transmitting information over the internet. HTTP is open text that's readable by anybody who intercepts the transmission.  Nobody should EVER use HTTP for any kind of sensitive work...even Facebook uses HTTPS:</span></div>

Web (in)Security

Yesterday, I received the following from CoveredCA: New! iPad Online Application: Replace "HTTPS" with "HTTP" in URL Address If you are using your iPad for enrollment and already have an URL saved to get to the open enrollment online application, you will need to update the URL Hyper Text Trans…

12Dec2014

GruberGate in 2 1/2 Minutes

GruberGate in 2 1/2 Minutes

[Hat Tip: Ace of Spades] …

12Dec2014

Killing Time

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<span style="font-family: Georgia, Times New Roman, serif;">Obamacare 2015 open enrollment is here. </span></div>
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<span style="font-family: Georgia, Times New Roman, serif;"><a href="http://cdn.theatlantic.com/static/mt/assets/science/mailletter.gif" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="103" src="http://cdn.theatlantic.com/static/mt/assets/science/mailletter.gif" width="200" /></a></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;"></span><span style="font-family: Georgia, Times New Roman, serif;">Good news is, the site seems to be working, kind of .........</span></div>
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<span style="font-family: Georgia, Times New Roman, serif;"><br /></span><span style="font-family: Georgia, Times New Roman, serif;">Bad news?</span></div>
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<span style="background-color: white; color: #333333; line-height: 23px;"><i><span style="font-family: Georgia, Times New Roman, serif;">Consumers there were having a hard time logging into their accounts, retrieving old passwords and proving they were who they said they were — a process known as identity proofing, which also vexed many people last fall. Some people did complete their applications at the Manassas clinic on Saturday, but it often took them<b> 90 minutes</b>.</span></i></span></blockquote>
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<span style="background-color: white; color: #333333; line-height: 23px;"><b><a href="http://www.nytimes.com/2014/11/16/us/health-insurance-marketplace-opens.html" target="_blank"><span style="font-family: Georgia, Times New Roman, serif;">NY Times</span></a></b></span></div>
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<span style="background-color: white; color: #333333; line-height: 23px;"><span style="font-family: Georgia, Times New Roman, serif;"><br /></span></span><span style="background-color: white; color: #333333; line-height: 23px;"><span style="font-family: Georgia, Times New Roman, serif;">Babies are birthed faster than that.</span></span></div>
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<span style="background-color: white; color: #333333; line-height: 23px;"><span style="font-family: Georgia, Times New Roman, serif;"><br /></span></span><span style="background-color: white;"><span style="color: #333333; font-family: Georgia, Times New Roman, serif;"><span style="line-height: 23px;">Who has 90 minutes, or longer, to wait to get into their account? And that's on top of queuing up at your local Obamacare office.</span></span></span></div>
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<span style="color: #333333; font-family: Georgia, Times New Roman, serif;"><span style="line-height: 23px;"><i>Similar problems frustrated Lorena Ortiz, 40, of Woodbridge, Va., who tried to switch plans in a conference room at the clinic that Ms. Burwell visited on Saturday. Ms. Ortiz had signed up for coverage in the first enrollment period, but could not remember the password for her account on HealthCare.gov.</i></span></span></blockquote>
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<span style="color: #333333; font-family: Georgia, Times New Roman, serif;"><span style="line-height: 23px;"><i>She and a certified application counselor, Kathleen May,<b> spent an hour trying to retrieve Ms. Ortiz’s old password</b> — even making a call to the HealthCare.gov call center — to no avail. They waited for a new password to come to Ms. Ortiz’s email address, but it never did.</i></span></span></blockquote>
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<span style="color: #333333; font-family: Georgia, Times New Roman, serif;"><span style="line-height: 23px;"><i>Then they tried creating a new account. At first that did not work, either, so they tried using a different email address for Ms. Ortiz. When Ms. Burwell walked into the conference room to greet clients, Ms. May and Ms. Ortiz did not even look up.</i></span></span></blockquote>
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<span style="color: #333333; font-family: Georgia, Times New Roman, serif;"><span style="line-height: 23px;"><i>They finally succeeded in creating a new account for Ms. Ortiz with a different email address. But <b>then they could not link her old health plan to her new account.</b></i></span></span></blockquote>
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<span style="color: #333333; font-family: Georgia, Times New Roman, serif;"><i><span style="background-color: white; line-height: 23px;"></span></i></span><br /></div>
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<span style="color: #333333; font-family: Georgia, Times New Roman, serif;"><span style="line-height: 23px;"></span></span><span style="color: #333333; font-family: Georgia, Times New Roman, serif;"><span style="line-height: 23px;">Smooth ..............</span></span></div>
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<span style="color: #333333; font-family: Georgia, Times New Roman, serif;"><span style="line-height: 23px;"><br /></span></span><span style="color: #333333; font-family: Georgia, Times New Roman, serif;"><span style="line-height: 23px;">Rube Goldberg would be jealous.</span></span></div>

Killing Time

Obamacare 2015 open enrollment is here. Good news is, the site seems to be working, kind of ......... Bad news? Consumers there were having a hard time logging into their accounts, retrieving old passwords and proving they were who they said they were — a process known as identity proofing, which …

12Dec2014

Helping Sarah Kliff Solve Her Medical Bill Issue

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Former WaPo Wonkblog health policy writer Sarah Kliff is a huge proponent of Obamacare and the expansion of health insurance. She's also been a recipient of excellent employer sponsored insurance benefits. Sarah has a problem. Here is what she tweeted:</div>
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<i>2/20 at 11:27am</i></div>
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<span style="color: #050005;"><u><i><b>Sarah Kliff</b>     <a href="mailto:%E2%80%8F@sarahkliff">‏</a></i></u></span><u><span class="username js-action-profile-name"><s><span style="color: #696669;"><i>@</i></span></s><b><span style="color: #050005;"><i>sarahkliff</i></span></b></span></u></div>
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<i>Received today an $820 medical bill that I was not expecting nor can I decipher because American health care.</i></div>
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<i>2/20 at 11:35am</i></div>
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<i><span style="color: #050005;"><b class="fullname js-action-profile-name show-popup-with-id">Sarah Kliff</b>     <a href="mailto:%E2%80%8F@sarahkliff">‏</a></span></i><span class="username js-action-profile-name"><s><span style="color: #696669;"><i>@</i></span></s><b><span style="color: #050005;"><i><a href="mailto:%E2%80%8F@sarahkliff">sarahkliff</a></i></span></b></span></div>
<div class="tweet original-tweet js-stream-tweet js-actionable-tweet js-profile-popup-actionable js-original-tweet                          with-social-proof focus" data-expanded-footer="<div class="js-tweet-details-fixer tweet-details-fixer">         <div class="entities-media-container js-media-container" style="min-height:0px">     </div>    <div class="js-machine-translated-tweet-container"></div>     <div class="js-tweet-stats-container tweet-stats-container ">     </div>      <div class="client-and-actions">   <span class="metadata">     <span>11:35 AM - 20 Feb 2014</span>               <a class="tweet-geo-text" href="//maps.google.com/maps?z=13&amp;ll=38.8936%2C-77.01458&amp;q=Washington%2C%20DC" target="_blank">from Washington, DC</a>          &middot; <a class="permalink-link js-permalink js-nav" href="/sarahkliff/status/436539675206221824"  tabindex="-1">Details</a>          </span> </div>   </div> " data-feedback-key="stream_status_436539675206221824" data-item-id="436539675206221824" data-name="Sarah Kliff" data-screen-name="sarahkliff" data-tweet-id="436539675206221824" data-user-id="19734832" data-you-block="false" data-you-follow="true" style="text-align: justify;">
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<i>I've never tried to negotiate down a medical bill before, but excited for this new personal and professional adventure!</i> </div>
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<span class="metadata">Sarah, please allow me to help you out.</span><br />
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<span class="metadata">First, you can't blame the American health care system as the reason for not being able to understand the bill. It's probably an issue with the coding - the little thing called ICD-9 soon to be ICD-10 that you<a href="https://www.blogger.com/null" target="_blank"> wrote about just a week ago</a>. If the coding was incorrect then the insurance company might have pended the claim until additional information was received.</span></div>
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<span class="metadata">Second, since the bill came from the provider my guess is that the $840 probably is retail charges. Having insurance provides you with a discount on the service. There are a few other things that could have caused you to receive the bill.</span></div>
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<li><span class="metadata">Could it be that the service isn't covered under your plan? </span></li>
<li>Could it be that you went to a non-network provider?</li>
<li><span class="metadata">Could it be because your plan has a deductible that you haven't met yet? </span></li>
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<span class="metadata">You need to find an EOB that matches up to the bill you received. You should also review your SBC to make sure that the healthcare service was covered under the plan. </span><br />
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These are the questions a professional advisor would be asking you. From there we would take your bill and your EOB and work with your provider and insurance company to have the claim fixed. It is NOT an easy process - something I'm sure you are finding out.</div>
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Helping Sarah Kliff Solve Her Medical Bill Issue

Former WaPo Wonkblog health policy writer Sarah Kliff is a huge proponent of Obamacare and the expansion of health insurance. She's also been a recipient of excellent employer sponsored insurance benefits. Sarah has a problem. Here is what she tweeted: 2/20 at 11:27am Sarah Kliff ‏@sarahkliff R…

06Dec2014

My new article is up...

My new article is up...

At Answers.com:"A Business Owners Policy offers a reasonably priced alternative to buying insurance coverage ala carte. By pre-packaging common benefits, and offering appropriate customization options, BOP's can save companies money and administrative headaches." …

06Dec2014

Oh, sure - NOW they tell us!

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<a href="https://blogger.googleusercontent.com/img/proxy/AVvXsEiIlMuVqVA57jT3eKUrwt-sRcXN7hqbnpvFKKmguRgu3Yu3BJ1l4eL916lu0YAJMW8ot59P7BxYy5bp2GyZDzvQSY7m44fmeRSKHhc6uXhPj6s3A9qgJTkr1hvYqQGPGE0Qpq7au0e2U5ZtX_OfGzJRdcvRl5PGKdNN4Dxy6Q0H2g=" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="300" src="http://ritakml.info/wp-content/uploads/2013/12/PiracyPicture.jpg" width="400" /></a></div>
<span style="font-family: Arial,Helvetica,sans-serif;">As we've long noted, the ObamaTax Exchange sites are a veritable <a href="https://www.blogger.com/null" target="_blank">treasure trove of ID-theft opportunities</a>. Turns out, though, we may have <i><b>under</b></i>-estimated the breadth and scope:<br /><br />"<a href="https://www.blogger.com/null" target="_blank"><i><span style="font-family: Times,"Times New Roman",serif;">Security experts worried that 35 state health exchange websites were vulnerable to hackers and were rated as "high risk" for security problems before ObamaCare's launch</span></i></a>"<br /><br />Really? That's a tad over 60% of the Exchanges, and they were <u><b>known</b></u> to be high-risk? Thanks, Ms Shecantbeserious, for the heads' up.</span></div>

Oh, sure - NOW they tell us!

As we've long noted, the ObamaTax Exchange sites are a veritable treasure trove of ID-theft opportunities. Turns out, though, we may have under-estimated the breadth and scope:"Security experts worried that 35 state health exchange websites were vulnerable to hackers and were rated as "high risk" f…

06Dec2014

Dabney Coleman gets...

Dabney Coleman gets...

The last laugh: …

06Dec2014

TRAGIC Wins Shallow Victory in SHBP Battle

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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjkn6KVT5urhkwwOOdFzN1vpiiVVe8sD23oDIYB52BG8VJI9liQ2NKaPw-DFl6orSxDKEYqbktVAfksiz37XAjTk3Uh7ELwGotBnKJEoAvUnqZbxco5G9otP8cu8LiSigEFSH6GSghfwZ4/s1600/tragic+shbp.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjkn6KVT5urhkwwOOdFzN1vpiiVVe8sD23oDIYB52BG8VJI9liQ2NKaPw-DFl6orSxDKEYqbktVAfksiz37XAjTk3Uh7ELwGotBnKJEoAvUnqZbxco5G9otP8cu8LiSigEFSH6GSghfwZ4/s1600/tragic+shbp.jpg" width="457" /></a>T.R.A.G.I.C, the teacher group we <b><a href="https://www.blogger.com/null" target="_blank">blogged about in January</a></b> formed to protest #Obamacare changes to the Georgia SHBP (State Health Benefit Plan) won a shallow victory. State and local government groups and school systems that use SHBP as their health plan received an email today, announcing <b><a href="https://www.blogger.com/null" target="_blank">retroactive changes</a></b> in the health plan.  </div>
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Readers may recall the uproar over the loss of copay plans and the announcement that BCBSGA was awarded the contract as the sole claims administrator for the health plan that covers 650,000 Georgia residents.</div>
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But Blue Cross was awarded the business in August of 2013 and there were no protests then.</div>
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During October SHBP particpants were given details on the new benefit packages. It was obvious there were no copay options. We had three choices, Bronze, Gold and Silver. All were high deductible HRA plans.</div>
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Where was TRAGIC then?</div>
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Crickets chirping</div>
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The state caved and agreed to overlay a doctor copay RETROACTIVELY to January 1, 2014. Yeah, that's going to be fun when Blue has to calculate refunds and then figure out if they restore dollars to an HRA or pay them to the policyholder.</div>
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So why is this a shallow victory?</div>
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The new copay's only apply to ER and doc visits.</div>
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Copay's do not count toward the major medical deductible.</div>
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SHBP participants still have the lousy Blue Cross POS limited provider network.</div>
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The Rx plan is still managed by Express Scripts. The amounts paid for Rx copay's still do not count toward the major medical deductible or OOP (out of pocket) limit.</div>
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Like I said. Shallow victory. The people behind TRAGIC fought to have doc copay's reinstated and completely missed the big picture.</div>
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Now that is tragic.</div>
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TRAGIC Wins Shallow Victory in SHBP Battle

T.R.A.G.I.C, the teacher group we blogged about in January formed to protest #Obamacare changes to the Georgia SHBP (State Health Benefit Plan) won a shallow victory. State and local government groups and school systems that use SHBP as their health plan received an email today, announcing retroact…

06Dec2014

Cavalcade of Risk #223: Call for submissions

Cavalcade of Risk #223: Call for submissions

Bob Wilson hosts next week's edition. Entries are due by Monday (the 8th).To submit your risk-related post, just click here to email it.You'll need to provide:■ Your post's url and title■ Your blog's url and name■ Your name and email■ A (brief) summary of the postPLEASE remember: ONLY posts t…

05Dec2014

Moving Goalposts (Again)

<div class="separator" style="clear: both; text-align: center;"><a href="https://jazzroc.files.wordpress.com/2008/11/goalposts.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="118" src="https://jazzroc.files.wordpress.com/2008/11/goalposts.jpg" width="140" /></a></div><div style="text-align: justify;"><span style="font-family: Arial,Helvetica,sans-serif;">So it appears that erstwhile Senate Majority Leader Harry Reid has conveniently forgotten the President's <i><b>explicit</b></i> promise to lower health insurance costs <a href="http://insureblog.blogspot.com/2010/03/health-insurance-premiums-drop-3000.html" target="_blank">by 3000%</a>. Today, Mr Reid was thrilled that:<br /><br />"<a href="http://thehill.com/blogs/floor-action/senate/225975-reid-lauds-low-healthcare-cost-increase" target="_blank"><i><span style="font-family: Times,"Times New Roman",serif;">Spending on healthcare grew in 2013 at the lowest rate ever recorded</span></i></a>."<br /><br />Which, while nice, rather misses the point: growing slower <i><b>≠</b></i> decreasing. Shame on you, Mr Reid.</span></div>

Moving Goalposts (Again)

So it appears that erstwhile Senate Majority Leader Harry Reid has conveniently forgotten the President's explicit promise to lower health insurance costs by 3000%. Today, Mr Reid was thrilled that:"Spending on healthcare grew in 2013 at the lowest rate ever recorded."Which, while nice, rather misse…

04Dec2014

(No) Need to Know

<div class="separator" style="clear: both; text-align: center;"><a href="https://annabelfrage.files.wordpress.com/2014/04/for-your-eyes-only-stamp.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="140" src="https://annabelfrage.files.wordpress.com/2014/04/for-your-eyes-only-stamp.jpg" width="140" /></a></div><div style="text-align: justify;"><span style="font-family: Arial,Helvetica,sans-serif;">Alt title: "<i>We could tell you, but then we'd have to kill you</i>."<br /><br />The story:<br /><br />"<a href="http://www.lifehealthpro.com/2014/12/02/3-things-you-cant-know-about-irs-ppaca-problems?eNL=547e46b3160ba0104fd05e28&utm_source=HCRW&utm_medium=eNL&utm_campaign=LifeHealthPro_eNLs&_LID=107687085" target="_blank"><i><span style="font-family: Times,"Times New Roman",serif;">[O]fficials at the Treasury Inspector General for Tax Administration ... are giving members of the public just enough information about a TIGTA review of IRS security testing to suggest that there might be cause for concern</span></i></a>."<br /><br />That's the take-away from security audits of the 404Care.gov site (which many of us have been using of late). Aside from the usual spinning wheels (both visual and metaphorical), there's a heightened sense that the site itself is just a bit, well, creepy: this morning, I met with a client who received a text message on her cell last Friday, admonishing her to complete her enrollment (which we're in the process of doing). But the overarching concern is that the site is unsecure, and the latest dope from DC does little to assuage this:<br /><br />"<i><span style="font-family: Times,"Times New Roman",serif;">TIGTA officials have put the results of their review in a heavily redacted report.</span></i>"</span><br /><br /><span style="font-family: Arial,Helvetica,sans-serif;">Just <i><b>how</b></i> redacted, you ask? Well, here's a sample 1000 words:</span><br /><br /><div class="separator" style="clear: both; text-align: center;"><span style="font-family: Arial,Helvetica,sans-serif;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYm552kTKBl5KsPqfBk1W42ftBcMcrN91U2T_0wLuaUt47_f1q63XzbYr2DNQvrRGLnx5nU_8eeW9ESoMLXyCAN3XDVVY1lkqGzWnoT6PXF9U0Wm4Fn37ZvaGKFdHGPA3z7VbUfYUKfik/s1600/404care+screencap.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYm552kTKBl5KsPqfBk1W42ftBcMcrN91U2T_0wLuaUt47_f1q63XzbYr2DNQvrRGLnx5nU_8eeW9ESoMLXyCAN3XDVVY1lkqGzWnoT6PXF9U0Wm4Fn37ZvaGKFdHGPA3z7VbUfYUKfik/s1600/404care+screencap.jpg" width="239" /></a></span></div><div style="text-align: center;"><span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: x-small;"><span style="color: red;"><i><b>[click image to embiggen] </b></i></span></span></span></div><br /><span style="font-family: Arial,Helvetica,sans-serif;">And that's just the highlights. Even the Table of Contents page is edited like that, and it only gets worse. One wonders, not unreasonably, what the folks at HHS and their partners are so concerned about letting us know. After all, their own resident guru <a href="http://insureblog.blogspot.com/2014/11/obamacare-moments-of-honesty.html" target="_blank">thinks we're too stupid</a> to understand it, anyway.<br /><br />And this statement, intended to make us feel all warm and fuzzy, does nothing to allay that sense of foreboding:<br /><br />"<i><span style="font-family: Times,"Times New Roman",serif;">Our concern is that the expected results should be accurate and complete in order for the testers to fully understand what they are testing and for the testers to be able to adequately compare the actual results to the expected results</span></i>."<br /><br />Un-hunh.</span></div>

(No) Need to Know

Alt title: "We could tell you, but then we'd have to kill you."The story:"[O]fficials at the Treasury Inspector General for Tax Administration ... are giving members of the public just enough information about a TIGTA review of IRS security testing to suggest that there might be cause for concern."T…

03Dec2014

Patrick Hits the Big Time (Once Again)

Patrick Hits the Big Time (Once Again)

Co-blogger Pat is once again featured at The Federalist, with his latest take on why rate increases are mist definitely built-in to O'Care. …

02Dec2014

Breaking News

Breaking News

This just in from the geniuses at the GAO.FLASH!As a result of Obamacare, Blue Cross expanded their market share in the majority of states at the expense of other carriers.Long version here.No (poop). …

01Dec2014

More GruberGate Cannon-fire

<div class="separator" style="clear: both; text-align: center;"><a href="https://img1.etsystatic.com/005/0/6612690/il_fullxfull.385791005_kmb6.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="111" src="https://img1.etsystatic.com/005/0/6612690/il_fullxfull.385791005_kmb6.jpg" width="140" /></a></div><div style="text-align: justify;"><span style="font-family: Arial,Helvetica,sans-serif;">As we've noted<a href="http://insureblog.blogspot.com/2010/01/herr-gruber-i-know-nussing.html" target="_blank"> for a while</a>, Herr Dr J Gruber has managed to talk himself into quite a corner. While making big coin (for apparently small work) designing and implementing the ObamaTax, casually demeaning the poor, feckless congresscritters who voted for it (that we might then learn what's in it), and then doubling down on both, he's managed to raise quite a few hackles.<br /><br />Once of his most vociferous - and successful - hacklers has been FoIB Michael cannon (oh, yeah, he's also the Cato Institute's director of health policy studies). Today, Michael has a special treat in store:<br /><br /><a href="http://www.cato.org/blog/grubergate-mini-series" target="_blank"><i><span style="font-family: Times,"Times New Roman",serif;"><span style="font-size: large;">Grubergate, the Mini-Series</span></span></i></a><br /><br />Presented in eight parts (from Stupid Voters through What the Future Holds), you'll be entertained and enraged (likely in equal measure). It's the Don't Miss hit of the season!</span></div>

More GruberGate Cannon-fire

As we've noted for a while, Herr Dr J Gruber has managed to talk himself into quite a corner. While making big coin (for apparently small work) designing and implementing the ObamaTax, casually demeaning the poor, feckless congresscritters who voted for it (that we might then learn what's in it), an…

01Dec2014

Obamacare's Bill of Goods: Subprime Insurance at Higher Costs

<br />The ACA promised us <a href="http://insureblog.blogspot.com/2010/03/health-insurance-premiums-drop-3000.html" target="_blank">$2500 per family savings</a> and better benefits. The reality is we are going to pay thousands of dollars more for our care and thousands of dollars more for our premiums. This is because of obscure provisions called the Applicable Percentage Table and the Annual Limitation on Cost Sharing. You’ve almost certainly never heard of these, yet both can deprive you of care and take a lot of money from your wallet.<o:p></o:p><br /><br /><b><u>Your Benefits Will Be Getting Worse</u></b><o:p></o:p><br /><br />The ACA sets limits on cost sharing to<b><i> </i></b><i><span style="mso-bidi-font-weight: bold;">protect</span></i> individuals from excessive out-of-pocket expenses. One of the concerns of ACA supporters revolved around high out-of-pocket limits for consumers. This amount, set at $6350 per person in 2014, was one of the largest objections individuals had when deciding what plan to purchase. Even with a subsidized premium, having to potentially come up with such a large percentage of their income to cover claims made coverage and care unaffordable. <o:p></o:p><br /><br />The Annual Limitation on Cost Sharing requires that these high out-of-pocket limits be updated annually. The formula for determining the new Maximum Out-of Pocket (MOOP) is based on the increase in average premiums per person for health insurance coverage. That means if premiums increase annually the MOOP will go up. For 2015 the premium adjustment percentage is 4.21% which increases how much you spend on medical care to $6600. That’s $250 more out of your pocket.<o:p></o:p><br /><br />According to the <a href="http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0CB4QFjAA&url=http%3A%2F%2Faspe.hhs.gov%2Fhealth%2Freports%2F2014%2FRateReview%2Frpt_RateReview.pdf&ei=mPQ7VMumMITgsATp44GwBA&usg=AFQjCNH609ZPhWwDvx_14o3HQ6eVGv7zag&sig2=keSZ0eU1CZcXOeV7eJGrMg&bvm=bv.77412846,bs.1,d.cGU"><span style="color: blue;">September 2014 HHS Rate Review Annual Report</span></a> small group health insurance premiums have increased substantially since 2008. As long as it continues we will see a higher MOOP every year. Worse yet, the growth rate of insurance premiums are still rising faster than average income and inflation. The result is clear: consumers will have worse insurance every year. The chart below shows what will happen to the MOOP at a (lower than average) 4% premium growth rate.<br /><span style="mso-no-proof: yes;"><v:shapetype coordsize="21600,21600" filled="f" id="_x0000_t75" o:preferrelative="t" o:spt="75" path="m@4@5l@4@11@9@11@9@5xe" stroked="f"><v:stroke joinstyle="miter"><v:formulas><v:f eqn="if lineDrawn pixelLineWidth 0"><v:f eqn="sum @0 1 0"><v:f eqn="sum 0 0 @1"><v:f eqn="prod @2 1 2"><v:f eqn="prod @3 21600 pixelWidth"><v:f eqn="prod @3 21600 pixelHeight"><v:f eqn="sum @0 0 1"><v:f eqn="prod @6 1 2"><v:f eqn="prod @7 21600 pixelWidth"><v:f eqn="sum @8 21600 0"><v:f eqn="prod @7 21600 pixelHeight"><v:path gradientshapeok="t" o:connecttype="rect" o:extrusionok="f"></v:path></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:formulas></v:stroke></v:shapetype></span><br /><div class="separator" style="clear: both; text-align: center;"><span style="mso-no-proof: yes;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiH7IzZ-9aNGenfERZpOaIjWNp0dtvn59U5jmB0S-fzIQ-ti7hinQEmyg_RAt5Zi6seLKlMPCY0RQhYm5V_ckVHmUTfC9mjotmTfV_rc3hYrq2xGef_D7mLfJAKbIGgfioeCPT2OVAFQh8/s1600/MOOP+at+4+percent+final.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiH7IzZ-9aNGenfERZpOaIjWNp0dtvn59U5jmB0S-fzIQ-ti7hinQEmyg_RAt5Zi6seLKlMPCY0RQhYm5V_ckVHmUTfC9mjotmTfV_rc3hYrq2xGef_D7mLfJAKbIGgfioeCPT2OVAFQh8/s1600/MOOP+at+4+percent+final.jpg" width="320" /></a></span></div><span style="mso-no-proof: yes;"></span>Under this scenario by 2018 an Obamacare-compliant plan will have an out-of-pocket maximum that is $1,000 more than it is today. Worse yet, the plans that are currently considered Silver plans will now be Gold plans. This is because of the "Actuarial Value Drift" my friend Bob Graboyes pointed out in this <a href="http://insureblog.blogspot.com/2014/10/no-you-cant-keep-your-plan.html"><span style="color: blue;">video and article</span></a>. <o:p></o:p><br /><br /><b><u>You Will Have To Pay More For Your Insurance Plan</u></b><o:p></o:p><br /><br />The percentage of your income you must pay for insurance will likely increase every year, too. When the rate of insurance premiums increases more than the rate of incomes another ACA provision is triggered. This is the Applicable Percentage of Income adjustment. <o:p></o:p><br /><br />In 2014 a family of four earning $59,625 is paying $4,800 for the baseline plan. Because of this adjustment, by 2019 this family will likely pay $5,725 for the new baseline plan. In six years this family will be paying $1,000 more for insurance premiums per year.<o:p></o:p><br /><br />The Congressional Budget Office explained in May of 2011 how these indexing provisions work, and recently CMS released the chart below showing how people will pay a greater percentage of their income for insurance next year.<o:p></o:p><br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhhziiIzrInDoPvOmAYHahjH0_-fXTTeO8HaelHNMFIXSKpRAuTIi2_pTWQERXh8Ck3yUrF7bZ1vKH92pAXoXDy82diQAzfHOc_wZ8j5qgxaMGakCeMRk9uP2lBR7YgL6BsJPfnefVM9As/s1600/Applicable+Percentage+of+Income+2014+vs+2015.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhhziiIzrInDoPvOmAYHahjH0_-fXTTeO8HaelHNMFIXSKpRAuTIi2_pTWQERXh8Ck3yUrF7bZ1vKH92pAXoXDy82diQAzfHOc_wZ8j5qgxaMGakCeMRk9uP2lBR7YgL6BsJPfnefVM9As/s1600/Applicable+Percentage+of+Income+2014+vs+2015.jpg" width="400" /></a></div><div align="center" style="text-align: center;"><span style="mso-no-proof: yes;"><v:shape id="Picture_x0020_3" o:spid="_x0000_i1025" style="height: 253.5pt; mso-wrap-style: square; visibility: visible; width: 417.75pt;" type="#_x0000_t75"> <v:imagedata o:title="" src="file:///C:\Users\paule\AppData\Local\Temp\msohtmlclip1\01\clip_image002.jpg"></v:imagedata></v:shape></span><o:p></o:p></div><br />These provisions bring to mind the subprime loan catastrophe that happened not long ago in the mortgage world. Consumers were sold low-interest loans and given high mortgage limits. Lenders didn't explain that the interest rates and payments would increase over time. The ACA's Applicable Percentage Table and Annual Limitation on Cost Sharing provisions work the same way. Over time you will pay more and get less. It's time these ACA shenanigans were brought to the forefront of the discussion.<br /><br />Because no one can afford to pay more for insurance that keeps getting worse.

Obamacare's Bill of Goods: Subprime Insurance at Higher Costs

The ACA promised us $2500 per family savings and better benefits. The reality is we are going to pay thousands of dollars more for our care and thousands of dollars more for our premiums. This is because of obscure provisions called the Applicable Percentage Table and the Annual Limitation on Cost S…