ACA insurance for 2018

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rainnyc
rainnyc Member Posts: 1,289

The Affordable Care Act is still with us, which is good news for those of us who are self-employed or have other reasons to buy their own insurance. But while Congress has not been able to repeal the law (yet), there are many changes this year to how insurance is purchased and far less support for consumers in the process. Open enrollment starts on November 1 and continues for six weeks, half the time period in previous years.

I'm not an expert, just a self-employed working stiff who needs the coverage. I've been buying insurance for myself and my family for many years, both before and after the implementation of the ACA.

I want to continue to use this thread not to debate the politics but to explore the practical aspects of getting coverage for ourselves under the ACA.

I found this article to be an enormously helpful rundown in changes to the sign-up period this year:

https://www.statnews.com/2017/09/28/patients-guide...


Comments

  • rainnyc
    rainnyc Member Posts: 1,289
    edited October 2017

    And an update about some of the challenges facing navigators. Kaiser Health News is a source of information that I've always found helpful and nonpartisan:

    http://www.benefitspro.com/2017/10/02/latest-snag-...

  • pupmom
    pupmom Member Posts: 5,068
    edited October 2017

    Thank you for getting this info out, rainnyc! DH and I don't use ACA, but many here do.

  • rainnyc
    rainnyc Member Posts: 1,289
    edited October 2017

    It will take a little while to see how this week's shifts in the ACA play out in our ability to get coverage for 2018. Earliest signs are that those who receive tax credits on their premiums will still receive them, thus, the price paid will be similar to 2017. But those who do not qualify for tax credits may see their premiums skyrocket.

    I found this summary from the NY Times helpful: https://www.nytimes.com/interactive/2017/10/14/us/...

    This one too: https://www.nytimes.com/interactive/2017/10/12/us/...

    This article is somewhat optimistic: https://www.nytimes.com/2017/10/13/upshot/trump-is...

    This website might be a helpful clearing house for information. I'd suggest signing up for their emails: https://getamericacovered.org

    On that site's homepage, if you click on "PRESS," and then "OE by the numbers," there is a chart with quite a bit of information, including some individual state dates that differ from the rest: https://assets.contentful.com/7cxqjss1irwa/6u8N8VF...

    More as I have it. Feel free to share other info, especially as information varies so much from state to state. And just a reminder, I want to use this thread for practical information rather than politics, as a couple of other threads here have that covered. Thanks.

  • keepthefaith
    keepthefaith Member Posts: 2,156
    edited October 2017

    Thanks for the info, Rainny. I am in the same boat. I guess we will be covered for 2018. 65 can't come soon enough for me.

  • rainnyc
    rainnyc Member Posts: 1,289
    edited October 2017

    You're welcome, keepthefaith. Good luck! Let us know how it goes this year, and I'll do the same.

  • Nancy2581
    Nancy2581 Member Posts: 1,234
    edited October 2017

    I don't have ACA, but our insurance is going up nearly $300.00 each month next year. It has consistently gone up at least $250.00 per month every year since we got it. My husband and I are 10 years away from Medicare. Don't know how we are going to do this. It's crazy stupid.

    Nancy

  • rainnyc
    rainnyc Member Posts: 1,289
    edited October 2017

    Nancy, are you buying your own insurance, i.e. not through an employer? We're also several years away from Medicare.

  • Nancy2581
    Nancy2581 Member Posts: 1,234
    edited October 2017

    yes we are buying our own insurance. I fear it's only going to get worse. I can't lose any of my current doctors as they watch me like a hawk lol.

    Nancy

  • Nancy2581
    Nancy2581 Member Posts: 1,234
    edited October 2017

    I know I feel for everyone.

  • farmerlucy
    farmerlucy Member Posts: 3,985
    edited October 2017

    FWIW We are able to purchase “group” insurance through our LLC, with my husband and I being the only members. It is ridiculously expensive, but at least we can get it. We just received notice that they are cancelling our current plan. BCBS is the only insurer available in Oklahoma. Disconcerting to say the least.
  • rainnyc
    rainnyc Member Posts: 1,289
    edited October 2017

    The last few days have been a bit confusing, and it's certainly not over yet! But with a focus on what things will mean for customers buying insurance for 2018, this updated article contains a bit of hope, even for those who don't receive government tax credits to purchase their insurance:

    https://www.nytimes.com/2017/10/18/upshot/trumps-a...

    I've been following the author of this article on twitter (see her byline), for those who might find that helpful.

  • amaasing
    amaasing Member Posts: 4
    edited October 2017

    I know I am probably in the minority, however in my opinion the ACA needs to go away. My son had a perfectly affordable health insurance that provided all the coverage needed to keep him protected and well. Then we were "required" to be a part of the ACA and his premiums sky rocketed every single year. Plus he no longer has the preventative coverage he once had due to the cost. He is stuck with a catastrophic plan that still cost twice as much as his regular health plan before ACA.

    He lives at home to save money and in order to receive any financial aid at all we have to disclose all of the household salaries which puts him over the limit for any aid. Needless to say, I am having to pay for his coverage and know that this approach to decent, preventative coverage for everyone has to go away and be replaced with something that actually works equally for all.

  • farmerlucy
    farmerlucy Member Posts: 3,985
    edited October 2017

    We received our 2018 quote for group coverage through our personal LLC. It only went up 4%. Not too bad, I guess.

  • pupmom
    pupmom Member Posts: 5,068
    edited October 2017

    Republicans have had 7 years to figure out how to "fix" the ACA. They now have control of all branches of government and still can't do it. Only real solution, IMO, is Medicare for all. DH and I are not on ACA, but our BC/BS premiums have gone up quite a bit. We don't mind paying if it means more people can have insurance. Of course, we can afford it, so easy for me to say, I guess.

  • peaches1
    peaches1 Member Posts: 137
    edited October 2017

    Hi- I don't visit here as much as I used to. My mammogram I had in June came back clean. Amassing are you declaring your son on your taxes. If you are then you have to factor in your income, but if you are not, then he should be able to apply for Obamacare based just on his income, and if he is 26 or younger he can be covered under your policy. I am glad that I am on medicare now, but I was on Obamacare the first year, and I would have not been able to afford insurance other wise. It still was not cheap, because I had some medical problems, and I ended up paying for $7,000 in medical expenses that my insurance did not cover. Since I've been on medicare, I only have to pay for my meds which are usually $12 a month. A few weeks ago, I visited the ophthalmologist, and medicare paid for the visit, but they did not cover the eye exam that his flunkies did so I could get new glasses, and I got charged $55 for that.

  • peaches1
    peaches1 Member Posts: 137
    edited October 2017

    Does anybody know when the marketplace plans will be posted for 2018? I have a friend whose son wants to apply. He was on Obamacare, and the company he was with two years ago Land of Lincoln went out of business in October of 2016, and left him with no insurance. He then got tired of all of the paperwork with Obamacare, and so he decided to not apply for it, and just get insurance on his own, but then he could not afford the payments, and he got dropped when he missed a few payments. He now wants to try to apply for Obamacare again, but he needs some help with the paperwork. He does not have the patience to do it all himself. I told my friend that Evanston Hospital has somebody that will help him apply for Obamacare, but I hope he can still get it, since he has not had insurance for at least 6 months and he has a preexisting condition.

  • Shellsatthebeach
    Shellsatthebeach Member Posts: 316
    edited October 2017

    Hi peaches, I'm thinking it would best for him to apply at this time before changes get made to Obamacare. Under the existing guidelines, he should not be denied.


    All Marketplace plans must cover treatment for pre-existing medical conditions," it reads. "No insurance plan can reject you, charge you more, or refuse to pay for essential health benefits for any condition you had before your coverage started. Once you're enrolled, the plan can't deny you coverage or raise your rates based only on your health."

    That's the law under the Affordable Care Act (better known as Obamacare). Not only must insurers offer those with preexisting conditions coverage, they can't charge people more for having those conditions and can't refuse to pay for essential health benefits — a slew of treatments and services defined elsewhere on the site. https://www.google.com/amp/s/www.washingtonpost.com/amphtml/news/politics/wp/2017/09/21/how-many-with-preexisting-conditions-would-be-priced-out-of-coverage-under-cassidy-graham/

  • rainnyc
    rainnyc Member Posts: 1,289
    edited October 2017

    Peaches, I believe that the plans must be posted by Nov. 1, but they don't have to be posted before then. As of a day or two ago, nothing was up on my own state's exchange.

    For all, here's a link to a terrifically helpful set of questions and answers, from the nonpartisan Kaiser Family Foundation, which studies and reports on health policy:

    https://www.kff.org/health-reform/faq/health-refor...


  • Beanie2017
    Beanie2017 Member Posts: 5
    edited October 2017

    farmerlucy: very disconcerting indeed. I am in Oklahoma also and received the same letter from BCBS telling us our plan would be cancelled also. It’s crazy.


  • swg
    swg Member Posts: 461
    edited October 2017

    Thanks! If it wasn't for the ACA, I KNOW I would never have gotten my dimple on my breast checked out. I just wouldn't. I would've convinced myself it was cellulite and saved the money it would cost to pay a dr out of pocket.

    The ACA is literally saving my life.

    That being said, I'm afraid of what my premium increase might be for 2018. I'm hearing 30-50% increases from some of my friends :(

  • swg
    swg Member Posts: 461
    edited October 2017

    If the ACA "goes away", many of us will die.

  • swg
    swg Member Posts: 461
    edited October 2017

    Tell your friend's son to go to healthsherpa.com

    That's how I signed up for the ACA last year, and it was super easy.

  • swg
    swg Member Posts: 461
    edited October 2017

    Sadly, I think it's going to get to the point where people will have to end up MOVING just to get affordable health insurance :(

  • rainnyc
    rainnyc Member Posts: 1,289
    edited November 2017

    The exchanges are open for next year's insurance. Margot Sanger-Katz at the NY Times has a good article about what's going on across the country:

    https://www.nytimes.com/interactive/2017/11/01/us/...

    At first glance, there are fewer choices in my area, downstate NY, than last year, though still more than in many parts of the country. The provider networks are getting narrower all the time. There are a couple of plans that come in around last year's rates, but most of the good plans are more expensive...

    More help...

    https://www.nytimes.com/2015/11/02/upshot/why-cons...


  • peggy_j
    peggy_j Member Posts: 1,700
    edited November 2017

    There's a webinar tomorrow (Wed) on enrolling in the ACA.

    Wednesday, November 8, 2017
    1:00pm Eastern Time

    https://www.canceradvocacy.org/cancer-advocacy/cpa...

    This organization, NCCS, National Coalition for Cancer Survivorship, was recommended here somewhere (by the Mods or ?). I attended one of their webinars in the past and it was good.

  • Lumpie
    Lumpie Member Posts: 1,650
    edited November 2017

    Many ACA plans have gone off the marketplace for 2018 where I live. I was just looking at some of the remaining non-HMO plans. There's Cigna and there are two very expensive CareFirst plans (>$1K/month). It's puzzling to me.... they ALL say that Herceptin and Perjeta - FDA approved, "standard of care" drugs for HER2+ disease - are not covered. Surely this must be an error...? I can't imagine that under the terms of the ACA, these drugs could be excluded from coverage. Anyone else found this?

  • rainnyc
    rainnyc Member Posts: 1,289
    edited November 2017

    Lumpie, that puzzled me the first time I shopped for an ACA plan after I was diagnosed. It turned out, at least in my state, that because Herceptin/Perjeta are given via infusion, they're not accounted for in the standard formulary of prescription drugs, but they are covered. They ARE standard of care. Maybe check with your MO's office to see how this is typically handled?

  • Lumpie
    Lumpie Member Posts: 1,650
    edited November 2017

    Thanks, rainnyc. Maybe that's it. I also read on another forum about a patient who was denied and forced to go through the appeals process but they ultimately covered the drugs. In the course of doing so, she learned that her insurance company makes all patients who need these drugs go through this burdensome, time consuming and stressful process ... but they ultimately get coverage for the drugs. (I have personally seen this in a number of other situations.) Crazy.

  • lovepugs77
    lovepugs77 Member Posts: 296
    edited November 2017

    When I looked at my chemo drugs (adriamycin, cytoxan, and taxol), it looked like they weren't covered, but they were. My MO's office called and got authorization before I started chemo. I didn't have to pay anything at all for it, because I had already met my out of pocket max.

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