Is Your Insurance Plan ACA Compliant?

[LoneLaugher]

To all USMB members who currently have employer sponsored health insurance plans:

Is the plan that you currently have ACA compliant?

Mine is.

 

[Rozman]

I doubt very much that my plan is Obama Care compliant.
First of all it's a good plan and it's affordable.
So right there I think I will be dropped.
Second I don't have any special Maternity,free birth control,Transgender training/conversion coverage.
And I don't think I'm covered for free panty liners or free feminine hygiene products.

So my plan is probably toast....

Thanks Libs

 

[LoneLaugher]

Don't you want to be sure?

 

[Rozman]

The president of the company told us at our last monthly meeting that our medical coverage
was going to change because of ObamaCare and that options were being looked into.
All kidding aside all those in my company who had health insurance will now have to deal with
having our coverage changed.

So again.Obama lied.We were not able to keep the plan we liked.

 

[Caroljo]

The insurance we have at work is compliant and won't be changed. We have a 3 tier plan, I have the "best" of the 3. It costs me approx $160/month in premiums. It's just me and my husband on the plan, our deductible is $1000 each / year. I checked to see what I'd be paying if we had to go through the exchanges......for the same type of plan, it would cost me over $700 month, our deductible would have been over $10,000 each. We make too much to get any subsidies. I'm so thankful because I would NOT be able to out what Obamacare would cost me!

 

[LoneLaugher]

The president of the company told us at our last monthly meeting that our medical coverage
was going to change because of ObamaCare and that options were being looked into.
All kidding aside all those in my company who had health insurance will now have to deal with
having our coverage changed.

So again.Obama lied.We were not able to keep the plan we liked.

Has your plan changed in some way every year that you have had it?

Are there people in your company that did not have health insurance?

 

[LoneLaugher]

The insurance we have at work is compliant and won't be changed. We have a 3 tier plan, I have the "best" of the 3. It costs me approx $160/month in premiums. It's just me and my husband on the plan, our deductible is $1000 each / year. I checked to see what I'd be paying if we had to go through the exchanges......for the same type of plan, it would cost me over $700 month, our deductible would have been over $10,000 each. We make too much to get any subsidies. I'm so thankful because I would NOT be able to out what Obamacare would cost me!

How much of the premium is paid by your employer now?

 

[OnePercenter]

Yes.

 

[OnePercenter]

The president of the company told us at our last monthly meeting that our medical coverage
was going to change because of ObamaCare and that options were being looked into.
All kidding aside all those in my company who had health insurance will now have to deal with
having our coverage changed.

So again.Obama lied.We were not able to keep the plan we liked.

Your coverage is going to increase. 'Looked into' is a lie, all businesses know exactly what is required.

 

[OnePercenter]

The insurance we have at work is compliant and won't be changed. We have a 3 tier plan, I have the "best" of the 3. It costs me approx $160/month in premiums. It's just me and my husband on the plan, our deductible is $1000 each / year. I checked to see what I'd be paying if we had to go through the exchanges......for the same type of plan, it would cost me over $700 month, our deductible would have been over $10,000 each. We make too much to get any subsidies. I'm so thankful because I would NOT be able to out what Obamacare would cost me!

Why is your employer charging you $160.00/mo?

 

[LoneLaugher]

This plan is $715 on the exchange for Michigan. No other Michigan exchange plan is in the $700 range. Is this the one you are talking about, Caroljo?

http://www.bcbsm.com/content/dam/pu...-plans/2014/blue-cross-silver-multi-state.pdf

 

[LoneLaugher]

This one is listed on the Michigan exchange for $807. Is this possibly it?

http://www.bcbsm.com/index/plans/michigan-health-insurance/gold/premier-ppo.html

 

[OnePercenter]

I doubt very much that my plan is Obama Care compliant.
First of all it's a good plan and it's affordable.
So right there I think I will be dropped.
Second I don't have any special Maternity,free birth control,Transgender training/conversion coverage.
And I don't think I'm covered for free panty liners or free feminine hygiene products.

So my plan is probably toast....

Thanks Libs

Why do you hate women?

On the flip side, I'm sure the women aren't very happy paying for your penis implant coverage!

 

[Caroljo]

The insurance we have at work is compliant and won't be changed. We have a 3 tier plan, I have the "best" of the 3. It costs me approx $160/month in premiums. It's just me and my husband on the plan, our deductible is $1000 each / year. I checked to see what I'd be paying if we had to go through the exchanges......for the same type of plan, it would cost me over $700 month, our deductible would have been over $10,000 each. We make too much to get any subsidies. I'm so thankful because I would NOT be able to out what Obamacare would cost me!

Why is your employer charging you $160.00/mo?

My part of the premium for 2 people is about $40/week. When I first got hired in (20 yrs ago) it was free. It's just been probably the last 6 to 8 yrs that we started having to share in the premiums.

 

[Caroljo]

The insurance we have at work is compliant and won't be changed. We have a 3 tier plan, I have the "best" of the 3. It costs me approx $160/month in premiums. It's just me and my husband on the plan, our deductible is $1000 each / year. I checked to see what I'd be paying if we had to go through the exchanges......for the same type of plan, it would cost me over $700 month, our deductible would have been over $10,000 each. We make too much to get any subsidies. I'm so thankful because I would NOT be able to out what Obamacare would cost me!

How much of the premium is paid by your employer now?

I'm not sure, I don't think I ever looked into it

 

[LoneLaugher]

The insurance we have at work is compliant and won't be changed. We have a 3 tier plan, I have the "best" of the 3. It costs me approx $160/month in premiums. It's just me and my husband on the plan, our deductible is $1000 each / year. I checked to see what I'd be paying if we had to go through the exchanges......for the same type of plan, it would cost me over $700 month, our deductible would have been over $10,000 each. We make too much to get any subsidies. I'm so thankful because I would NOT be able to out what Obamacare would cost me!

How much of the premium is paid by your employer now?

I'm not sure, I don't think I ever looked into it

Well, it is a very pertinent question. Your employer used to pay 100% of the premium until 6-8 years ago. It is possible that you are only paying 20% of the premium now? Some employers.....those who value their employees and wish to provide benefits...still cover the bulk of premiums.
If that were the case, your plan actually costs $800 per month now.

Might want to check that out.

http://kff.org/report-section/2013-summary-of-findings/

The average employee contribution into family plans is about 30%.

 

[Caroljo]

This plan is $715 on the exchange for Michigan. No other Michigan exchange plan is in the $700 range. Is this the one you are talking about, Caroljo?

http://www.bcbsm.com/content/dam/pu...-plans/2014/blue-cross-silver-multi-state.pdf

I never actually got to see what that plan covered, all I was given was what it would cost me, so this could be the one. We do have BCBS, but it's not a Multi-state plan.
Here I copied/pasted the first page of the plan we have...it doesn't want to lay out correctly but you can get the idea. The higher percentage is if we use services "in network". I was actually wrong on the deductibles...they're lower than I stated.


In-Network
Out-of-Network
Deductible, Copays/Coinsurance and Dollar Maximums
Deductible - per calendar year
$600 per member
$1,200 per family
$1,200 per member
$2,400 per family
Copays
• Fixed Dollar Copays
$35 copay for:
 Chiropractic Spinal Manipulations
 Office Visits
 Office surgery
$45 copay for:
 Urgent Care Services
$115 copay for:
 Emergency Room (copay waived if admitted or accidental injury)
$115 copay for:
 Emergency Room (copay waived if admitted or accidental injury)
Coinsurance
• Percent Coinsurance
20%, unless otherwise noted
30%, unless otherwise noted
Note: Services without a network are covered at the in-network level.
Out-of-Pocket Maximum
Includes Deductible, Coinsurance and Copays
excludes private duty nursing
$2,000 per member
$4,000 per family
$2,600 per member
$5,200 per family
Lifetime Maximum
Unlimited
Preventive Services
Health Maintenance Exam - one per calendar year
Covered - 100%
Covered – 80%
Routine Physical Related Test - X-Rays, EKG and lab procedures performed as part of the health maintenance exam
Covered - 100%
Covered – 80%
Annual Gynecological Exam – two per calendar year, in addition to health maintenance exam
Covered - 100%
Covered – 80%
Pap Smear Screening - one per calendar year
Covered - 100%
Covered – 80%
Mammography Screening - one per calendar year
Covered - 100%
Covered – 80%
Contraceptive Methods and Counseling
Covered – 100%
Covered – 80%
Prostate Specific Antigen (PSA) Screening - one per calendar year
Covered - 100%
Covered – 80%
Endoscopic Exams - one per calendar year
Covered - 100%
Covered – 80%
Well Child Care
 6 visits per calendar year to age 35 months
 2 visits per year, 36 months to 47 months
 1 visit per year, ages 4 through adult
1. visits to a physician to monitor the development of a child
Covered - 100%
Covered – 80%
Immunizations -Pediatric & Adult
Covered - 100%
Covered – 80%
Physician Office Services
Office Visits
Covered - 100% after $35 copay
Covered - 70% after deductible
Pre-Surgical Consultations
Covered - 100% after deductible
Covered - 100% after deductible

A lot of the other coverages are mostly 80% to 100% covered also. We have a very good plan, better than the one you linked to. One I noticed is on the one you linked, for Skilled Nursing care you can only be covered for 45 days, and they cover 80% after deductible AND $500 copay. This same coverage on my plan....they cover 120 days & 80% after deductible (no co-pays).

So needless to say....I'm happy with mine!

 

[Caroljo]

How much of the premium is paid by your employer now?

I'm not sure, I don't think I ever looked into it

Well, it is a very pertinent question. Your employer used to pay 100% of the premium until 6-8 years ago. It is possible that you are only paying 20% of the premium now? Some employers.....those who value their employees and wish to provide benefits...still cover the bulk of premiums.
If that were the case, your plan actually costs $800 per month now.

Might want to check that out.

2013 Summary of Findings | The Henry J. Kaiser Family Foundation

The average employee contribution into family plans is about 30%.

I'm sure it probably is at least that amount! And I'm thankful that we work for a company (my husband and I both work there) that does treat their employees very well. If they had to drop our insurance, we would not be insured because I couldn't afford it!

 

[LoneLaugher]

I'm not sure, I don't think I ever looked into it

Well, it is a very pertinent question. Your employer used to pay 100% of the premium until 6-8 years ago. It is possible that you are only paying 20% of the premium now? Some employers.....those who value their employees and wish to provide benefits...still cover the bulk of premiums.
If that were the case, your plan actually costs $800 per month now.

Might want to check that out.

2013 Summary of Findings | The Henry J. Kaiser Family Foundation

The average employee contribution into family plans is about 30%.

I'm sure it probably is at least that amount! And I'm thankful that we work for a company (my husband and I both work there) that does treat their employees very well. If they had to drop our insurance, we would not be insured because I couldn't afford it!

Well,

If your company dropped your insurance, you would have a legitimate claim to increased salary. In effect, the portion of the premium that is being paid by your employer is part of your compensation package. You are paying for it now.....but the money is going directly to the insurance company from your employer.

You do understand that, don't you?

 

[Caroljo]

This one is listed on the Michigan exchange for $807. Is this possibly it?

Individual Health Insurance - Blue Cross Premier Gold - Blue Cross Blue Shield of Michigan

This one still isn't as good as what I have! Our co pay this year did go up to $35. Our emergency room visits are only $115. Also, our max co-pay and max deductibles are much less than this one