Checking Out the Obamacare Exchanges

Posted on October 2, 2013. Filed under: Obamacare | Tags: , |

Who Benefits from Obamacare? Democrats, Republ...

Just like millions of other people, I went to my local state exchange (, and like most people, I had trouble getting information. I’m sure the system was overwhelmed by people signing up and by lookie-loos like myself. For all the railing and hyperbole I’ve been spewing over the last few months, I decided to go and have a look at some of these plans for myself.

There are those out there who are already ridiculing the system because many of them crashed yesterday, or were giving out wrong information at times. I’m not going to be one of those. Whenever a new system such as this is rolled out, there will be a certain amount of time required to fix all the glitches, and I’m sure they were not prepared for the number of people that came to the sites yesterday, although they should have been, because this always happens.

It was kind of funny, though.

The cheapest plan for me, being 47 years of age at the time this goes into effect, and a tobacco user, the cheapest premium would be $139 a month, and that’s just for “catastrophic” coverage with a deductible of $6350.

For those who don’t know, catastrophic coverage is for unexpected hospital expenses or serious illness. This means that “preventative” care is not covered. So, buying this plan, I would not be able to see a regular doctor.

That coverage is through Healthnet, who the LA Times highlighted as having the fewest doctors in their network.

My other option would be Health Republic, with a premium of $200 a month for that same coverage.

These plans are both more than what I pay now, and are the plans the President touted as being cheaper than your cable or cell phone bill. In both cases, this is not true for me.  But what kind of coverage is this? This seems to me to be supplemental coverage, not “health insurance”.

As I peruse the list, really the only insurance/HMO I have heard of is Kaiser, and they offer most of the plans. I’ve heard of Moda Health, only because they bought the naming rights to the Rose Garden (where the Portland Trail Blazers play).

Pacific Source weighs in with the highest catastrophic plan premium: $341 a month; The deductible and OOP cap is $6350.

With the higher premium, is there greater access to hospitals that accept it? My wife has Pacific Source, and she hates it. She says she would rather go back to Kaiser (which is scary in its own right).

From the catastrophic coverage, the plans move to bronze, silver, gold and platinum (for the rich people).

The cheapest Bronze plan is from Moda, at $202 a month, with a deductible of $5k, and max out of pocket (OOP) expenses of $6350.

But, once again, one has to wonder how many doctors are in the network. At this time, the cover Oregon site does not allow one to investigate such details.

Pacific Source comes in again with the most expensive Bronze plan, at $396 a month, and a deductible/OOP of $6350. So, I pay them twice what I would pay Moda for a higher deductible? I thought the higher deductible was supposed to mean lower prices.

The cheapest silver plan also comes from Moday, which is $237 a month for a $2500 deductible, and OOP capped at $6000. More doctors and more hospitals are available, and honestly, that isn’t really that bad a price, but I have no idea how good their doctors are. This is also cheaper than a lot of the bronze plans offered. That said, for me this would be a 100% increase for lesser coverage than I have now.

Pacific Source is again the high price leader, at $483 a month, but now the deductible has dropped to $1500, but the OOP remains at $6350.

Getting into the gold level, Health Net offers the cheapest insurance, at $301 ($1300/$6350), while again, Pacific Source is the most expensive at $581 ($1300/$6350), $100 more than the next most expensive policy.

I’m not even going to look at Platinum plans. I can’t even afford the Gold plans.

A lot of the difference in the plan levels, however, is the access to doctors. I pointed out in a previous post a Los Angeles Times article talking about different insurers in California, and how access to them has shrunk due to low premiums. I also said that the Moda $237 a month silver plan isn’t that bad, but how many doctors/hospitals are in their network? I cannot currently find that information out, because the Oregon exchange website is not working correctly. I can’t compare plan details. I can see that Moda has the plan I just mentioned, but they have another plan for $305 a month with a $1000 deductible, but again, I can’t see the details of the plan.

I should also point out that as a smoker, these premiums are about 20% higher than if I were a non-smoker. That’s okay. I’m an adult who engages in behavior that is risky, but that’s my choice. However, I do take umbrage that the website does not ask me if I’m a meth or heroine user, or  an alcoholic, Those behaviors are just as risky, if not moreso, than smoking. In Oregon, smokers are constantly being singled out, while drug users are coddled.

I was also informed that because of my household income, I am not eligible for subsidy (which is okay, I hate the idea of the taxpayers paying for other people’s insurance).

Which brings me to……

One of the things touted by Obama and DHHS is that kids can stay on their parent’s insurance plans until the age of 26.

So 26, is the new 18.

Obamacare is dependent on millions of young people to sign up for insurance to offset the costs of the seniors and sickly who will be subsidized.

How are these kids to sign up if they are still on their parent’s plan? It makes no sense to me.

If someone turns 18 and has to get health insurance, if they make a lot of money (say, $100,000 annually), Kaiser has a gold plan ($0/$6350) for $162, and a catastrophic plan as low as $57 a month. However, if you reduce the annual income to $20,000, the premiums for this hypothetical person jump. The cheapest insurance (through Moda) becomes  a silver plan for $96 a month ($250/$500). Kaiser’s gold plan disappears completely. The most expensive is through the Oregon Health Co-op, at $153 (N/A deductible/$1500 OOP). For an income of $20k, $67 of this is subsidized.

For seniors, and I will use my mother as an example, there is a silver plan available for $453 (again, through Moda), and she would have a subsidy of $454 to cover it, so this plan would be free to her (but not free to the rest of us). However, she would still be responsible for the $2500 deductible and $6000 OOP cap.

As she gets older, and is a higher risk, how is she supposed to afford the OOPs and deductibles on her $10k fixed income?

I have no issue with helping seniors on fixed incomes. Since most of them are no longer working, they are on tiny fixed incomes with which to pay rent, food and utilities.

How is it that the higher the income, the lower the premium, at least for the young? If you cut my income in half, I would still not get a subsidy, but the rates would remain the same as if my income were double, but it would be harder for me to pay each month.

This experiment shows that the youth would have lower premiums, and about 50% would be subsidized. It also shows that the premiums for seniors would be much higher (they carry higher risk), but it those of us stuck in the middle, those of us at or near middle age, who are carrying the burden or Obamacare. We don’t get the subsidies, at least for incomes above $36,500 (which is most of us). The trade off is that most of the youth would not use their insurance unless they really needed to.

These are just the numbers for me (my wife has insurance). If you put in for a family of 4, that’s where the premiums really get out of control. Kids are expensive, so how is a family of four supposed to afford a plan of $568 a month ($5250/$6350) [Gold plans are more than $1000 a month]? A household income of $100k a year yields no subsidies, and before you start in about how $100k is very well off, it isn’t anymore, especially with kids. $100k is a combined household income that I just threw out there. $87,000 seems to be where the subsidy cutoff is.

The President thinks that people will start to like the law once they see how it works. I don’t agree. I think that as people start seeing their premiums and learn the restrictions on how many doctors are available, more people will turn against it. It is a burden on the middle class. Just like the Alternative Minimum Tax, more people in the middle class will be swept up accidentally.

He also likes to tout how people got refunds this last year. Yeah, thanks for the $15 bucks there, Mr. President. You’re really charitable.

Here’s the kicker. It’s a bait and switch. The premiums quoted on the website may not be the premiums you receive. The final premium is dependent on what you say in your paperwork. It could be higher, it could be lower. There is no way to know until you have completed your enrollment. At that point, can you say “no, thank you”?

The mandates for business have been pushed back a year, but the people are still on the hook through the individual mandate, and the Democrats are refusing to push it back a year.

Do you need any bigger hints as to who really controls the government?

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