Wednesday, November 6, 2013
Obamacare sucks!
OK, so I spent 45 minutes on the Covered California web site today and then 30 minutes on their 800 "help" line. The result after spending 75 minutes registering/applying/shopping for good quality affordable health insurance on this so-called health-care "exchange" was access to the Blues: An Anthem Blue-Cross individual policy for $289 per-month (for just myself). Or an Anthem Blue-Cross Health Savings Account (HSA) policy for $291 per-month. These were the only two policies under $300.
Right off the bat there's something seriously wrong with the pricing of these contracts when a PPO with some, albeit very limited, first dollar coverage is less expensive than a health savings account. The HSA should be the least expensive insurance contract in the insurance company's portfolio. Why? because the low monthly premium is supposed to help free up after tax dollars that can be deposited into a tax-deductible health savings account, similar to the way you deduct annual contributions to an Individual Retirement Account. The money then grows tax free inside the HSA and can then be accessed penalty free when you pay for qualifying health care expenses. But I digress.

The better policy of the two I found, has a $5,000 annual deductible, a $6,350 out-of-pocket maximum (this includes my deductible but NOT my monthly $289 premium). So in actuality my annual out of pocket max with this policy would be $9,818. This in and of itself isn't a bad thing. I think any maximum out of pocket between $7,500 and $10,000 is cost effective assuming a functioning market place. But that is not we have anymore thanks to Obamacare. So as you will see it gets worse.

Plan Benefits:

·         $60 regular office-visit co-pay AFTER my $5,000 deductible.
·         $70 co-pay for specialists AFTER my $5,000 deductible
·         $60 co-pay for "other practitioner office visits" AFTER my $5,000 deductible
·         $300 co-pay for emergency room services AFTER my $5,000 deductible
·         $120 co-pay for urgent care AFTER my $5,000 deductible
·         30% co-insurance for hospital stays AFTER my $5,000 deductible
·         30% co-insurance for lab work, diagnostics & ex-rays AFTER my $5,000 deductible
·         $50 pcs co-pay for name-brand drugs / $19 pcs co-pay for generic drugs (probably the most reasonable feature of the plan, however the generic co-pay is a little high).
Usually a generic pcs co-pay is in the $10 to $15 range. And an important question that should be known is what happens if there is NO generic equivalent available? Or, another scenario, which happens on occasion, is what if your doctore insits on the name brand drug. Most good insurance contracts will allow the insured to pay the generic co-pay in that situation.
So frankly the benefits above are pretty awful. Incredibly high co-pays but only after extremely high deductibles. I have never seen this sort of thing before. At least not here in California.
But here's some good news. If I get pregnant and use my prenatal and postnatal benefits, I pay ZERO co-pays and ZERO deductible! Only problem is I'm physically incapable of getting pregnant as I am a male. Moreover, I am incapable of getting a woman pregnant as I had a vasectomy in 2001 after my 4th child was born. So this benefit is absolutely worthless...but very costly to include. In essence I am paying for a benefit I could never use.

As some of you know, I sold health insurance here in California in the individual and small group market between 1998 and 2006. I had over 100 small businesses insured and over 250 individuals insured. And I can honestly say this is the worst insurance policy I have ever come across. Indeed if I had come across a prospective client who had this policy I would’ve had a guarantee sale. In fact, I would've starved to death is this was all I had to offer my clients.

Posted at 20:57 PM By admin | Permalink | Email this Post | Comments (0)

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