Author Topic: Insurance Outside the Healthcare Exchanges?  (Read 2119 times)

RichardP

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Insurance Outside the Healthcare Exchanges?
« on: October 02, 2013, 03:45:11 PM »
I'm suddenly questioning my understanding of the new ACA Metal Plans.  This is my thinking.  Could someone please verify whether I am thinking correctly.

1.  Any insurance company that wants to can continue offering private insurance plans, subject to the State regulations in which the plan is offered.

2.  The plans offered in Point 1 are outside of, and unaffected by, the requirements imposed on the healthcare plans that may be offered through the Healthcare Exchanges.

3.  The ACA establishes a requirement for Healthcare Exchanges that will either be run by the individual state, or by the Federal government if the state declines to run the exchange.  All states must have a Healthcare Exchange.

4.  Any individual insurance carrier may choose whether to offer insurance plans through a given state's Healthcare Exchange.

  a.  If a carrier does choose to offer a plan through the exchange, it must conform to the requirements published for the Metal Plans:  Bronze, Silver, Gold, and Platinum.

  b.  Any carrier offering insurance plans through the Healthcare Exchanges may still offer other non-exchange plans to the public, subject to state regulations (only?).

5.  Specifically - the only required Metal Plans are the ones offered through the Healthcare Exchanges.  The plans offered outside of the Healthcare Exchanges are not Metal Plans, and are not subject to the rules imposed on the Metal Plans.

I thought I understood Point 1-5 pretty well.  But now I am hearing from some that ALL health insurance plans must be Metal Plans, whether they are part of the Healthcare Exchanges or not.  Now I'm wondering whether they are confused, or I am confused.

I'm thinking they are confused - that the requirements for Metal Plans are only for those plans offered through the Healthcare Exchanges.  All plans outside of the exchanges are not Metal Plans (or at least don't need to be).  Correct, or no?

At a minimum, we know that this is true:

While the fundamental purpose of the exchanges will be to facilitate the offer and purchase of health insurance, nothing in the law prohibits qualified individuals, qualified employers, and insurance carriers from participating in the health insurance market outside of exchanges. Moreover, ACA explicitly states that enrollment in exchanges is voluntary and no individual may be compelled to enroll in exchange coverage.

From second paragraph of Summary, here:
http://www.fas.org/sgp/crs/misc/R42663.pdf

There is also this, from the bottom of Page 30 - top of Page 31 at that link:

In general, exchanges will offer comprehensive coverage that meets the standards to be certified as “qualified health plans” (QHPs), provided it meets requirements related to marketing, choice of providers, plan networks, and other features, or is recognized by each exchange through which such plan is offered.  In addition, all QHPs are required to comply with ...

Plans that are offered both inside and outside of exchanges must charge the same premium. In addition, ACA allows the types of health plans that are currently offered in the private market to continue to be offered once the exchanges have been established, as long as those other plan types comply with applicable federal and state law. ...

An issuer of QHPs must be licensed and in good standing with each state in which it offers coverage; must offer at least one QHP each providing silver and gold levels of coverage; and must comply with regulations applicable to exchanges. An issuer may offer QHPs outside of exchanges as well as inside, but the premiums would have to be the same, even if the QHP is sold through an insurance agent.


The language in the first quote states that insurance carriers can offer more insurance plans to the public than what they offer through the Exchanges.

The language in the second quote states that insurance carriers can offer outside of the Exchanges the same plans they offer inside of the Exchanges.

But I can't tell from that language whether plans sold outside of the Exchanges,  that are also sold through the Exchanges, must be labled Bronze, Silver, Gold, and Platinum also.  I'm thinking that somebody passing by this post will know for certain.
« Last Edit: October 02, 2013, 06:19:22 PM by RichardP »

PMRNC

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Re: Insurance Outside the Healthcare Exchanges?
« Reply #1 on: October 02, 2013, 06:42:58 PM »
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I'm suddenly questioning my understanding of the new ACA Metal Plans.  This is my thinking.  Could someone please verify whether I am thinking correctly.

I'm sorry Richard I can't resist.. what are Metal Plans..? LOL (all in good jest)


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1.  Any insurance company that wants to can continue offering private insurance plans, subject to the State regulations in which the plan is offered.

Correct in regards to premium and caps and they have to abide by the minimum standards of the ACA in order for Tax payers to avoid the penalties and/or receive tax credits.


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2.  The plans offered in Point 1 are outside of, and unaffected by, the requirements imposed on the healthcare plans that may be offered through the Healthcare Exchanges.

No, the ACA is a federal law and requirement, plans will have to still adhere to the minimum needs of the ACA.


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3.  The ACA establishes a requirement for Healthcare Exchanges that will either be run by the individual state, or by the Federal government if the state declines to run the exchange.  All states must have a Healthcare Exchange.

Correct.. sort of.. No carrier is obligated to participate in state exchanges. Many states will see a big problem with lack of carrier participation, for example California and Texas.  Premiums will logically run higher in the states where the feds had to come in to run them (that's their punishment. LOL)


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4.  Any individual insurance carrier may choose whether to offer insurance plans through a given state's Healthcare Exchange.

Correct. Carriers are limited by range of risk and geographical area, if they so choose to enter the exchanges they are agreeing to operate ONLY in those areas (FOR THE METAL PLANS). That is why in some states it was NOT beneficial to certain carriers to be limited by ONE state's exchange.. again, example : California


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  a.  If a carrier does choose to offer a plan through the exchange, it must conform to the requirements published for the Metal Plans:  Bronze, Silver, Gold, and Platinum.

Yes, they will have options though in underwriting out of pocket costs/plans.

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  b.  Any carrier offering insurance plans through the Healthcare Exchanges may still offer other non-exchange plans to the public, subject to state regulations (only?).

No, I don't beleive so but I'm not 100% positive, I beleive they agree with the exchanges to operate within a special area of exchanges, however companies such as Aetna, for example, won't lose any market because of their multi=state operations.

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5.  Specifically - the only required Metal Plans are the ones offered through the Healthcare Exchanges.  The plans offered outside of the Healthcare Exchanges are not Metal Plans, and are not subject to the rules imposed on the Metal Plans.

The ACA is a federal law so ALL plans must adhere to ACA MINIMUM standards. The difference will be that they don't have to adhere to the caps and can offer on the private market and multi-state. consumers buying outside the exchange can STILL qualify for tax credits if eligible.. remember the law says All MUST HAVE HEALTHCARE PLANS. The ACA are just mandates set forth to minimum of standards for ALL insurance plans. Democrats really thought they were putting screws to carriers but they were not.. they don't really compete like people think, all rates are comparable as they talk to each other and depend on a uniform set of risk management standards.

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I thought I understood Point 1-5 pretty well.  But now I am hearing from some that ALL health insurance plans must be Metal Plans, whether they are part of the Healthcare Exchanges or not.  Now I'm wondering whether they are confused, or I am confused.

The plan levels (Bronze, gold, purple, whatever) are just LEVELS of benefits .. EACH one will meet the MINIMUM standard but of course the nicer plans will have the higher premium and lower out of pocket (or in their minds.. AFFORDABLE).   Remember not everyone will qualify for tax credits.. 400% below poverty. .Don't get me started on that.. if your a hardworking American screw you but let the non working welfare recipient get free care after tax credits.

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While the fundamental purpose of the exchanges will be to facilitate the offer and purchase of health insurance, nothing in the law prohibits qualified individuals, qualified employers, and insurance carriers from participating in the health insurance market outside of exchanges


I really guess this is left up to everyone to interpret, I've quit trying to figure out the intentions of our polticians. I do know the word "Affordable" is nothing but a mere JOKE.. "Accessible" maybe.. but "affordable" is left up to you to interpret it how you need to.

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But I can't tell from that language whether plans sold outside of the Exchanges that equal plans sold inside of the Exchanges are to be labled Bronze, Silver, Gold, and Platinum also.  I'm thinking that somebody passing by this post will know for certain.

No, the private market will be able to offer whatever plans they want but they still must meet the MINIMUM standards of the ACA in regards to coverage. While it would seem this is a loss to carriers because who's going to buy on the private market when they can get cheaper rate in the exchanges? ,  It does NOT effect the carriers who participate in multi state plans.. the reason SOME carriers chose NOT to participate in some states and not others came down to a choice between production and volume of plans sold and types. So for example, Aetna (just an example) could choose to participate in NY, NJ but not CT because their market/productivity is solid in those states.

Good questions Richard!! I was beginning to think I was the only one who spent all the last 2 years reading the bill. <g>
« Last Edit: October 02, 2013, 06:44:41 PM by PMRNC »
Linda Walker
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PMRNC

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Re: Insurance Outside the Healthcare Exchanges?
« Reply #2 on: October 02, 2013, 06:48:37 PM »
Another thing important to remember in understanding how this effects insurance carriers is this:   THE big 5 are not worried as they make their money off the larger GROUP plans. When was last time you read an article from a major carrier upset with the ACA?? LOL you won't because they really don't care one way or another, they will still make the same profit, there is NO competition like our politicians are telling us there are!!  If you look at the exchanges rate in your state you'll see that.. that is why when you shop the exchanges you don't get to pick from a list.. <g> 
Linda Walker
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RichardP

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Re: Insurance Outside the Healthcare Exchanges?
« Reply #3 on: October 02, 2013, 08:19:58 PM »
I'm sorry Richard I can't resist.. what are Metal Plans..?

Heavy metal??

RichardP

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Re: Insurance Outside the Healthcare Exchanges?
« Reply #4 on: October 02, 2013, 09:56:10 PM »
Thanks for the detailed response Linda.  It hadn't really clicked with me that the ACA puts a floor on what has to be included in health insurance coverage for all states.  I have been focusing more on the Health Insurance Exchange part.

While it would seem this is a loss to carriers because who's going to buy on the private market when they can get cheaper rate in the exchanges?

From the last sentence of the last paragraph I quoted above:

An issuer may offer QHPs outside of exchanges as well as inside, but the premiums would have to be the same, even if the QHP is sold through an insurance agent.

I think that is stated several times at the bottom of Page 30 and top of Page 31 at the link I gave.  This gives the insurance carriers the ability to offer the same thing for the same price, both inside and outside of the Exchange.  Which raises the question in my mind - if this is true, and if the carriers take advantage of it, why bother with the Exchange - unless you need a subsidized policy?

Someone I know has a catastrophic coverage plan for their family (about $300 per month).  They just received notice that their coverage will no longer be available.  And the only plan that will be made available for that coverage from that carrier will cost about $700 per month - more than double what they are currently paying.  Their letter made some mention about the metal plans.

We have a family plan with Blue Cross of California.  Today in the mail we got a notice that our plan is no longer available and we will have to choose something different in a while.  They will send us more information later.  The letter made some mention of the metal plans.

We don't begin to qualify for any kind of coverage subsidy on the Exchange, and neither does the friend with the catastrophic coverage.  Ensuing conversations with both wife and friend led to some confusion, which led to my questions stated in my first post - because of the mention of metal plans in the letters both to my friend and to us.

RichardP

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Re: Insurance Outside the Healthcare Exchanges?
« Reply #5 on: October 02, 2013, 10:11:42 PM »
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4b.  Any carrier offering insurance plans through the Healthcare Exchanges may still offer other non-exchange plans to the public, subject to state regulations (only?).

No, I don't believe so but I'm not 100% positive, I beleive they agree with the exchanges to operate within a special area of exchanges, however companies such as Aetna, for example, won't lose any market because of their multi=state operations.

My Point 4b was meant to be a statement, not a question.  The only part that was a question is whether the non-exchange plans would be subject to more than just state regulations.  You answered that question by reminding us that the ACA puts a floor under what may be offered outside of the exchanges, for all states.

The quote I gave from the Summary, as well as the paragraphs from the bottom of Page 30 and the top of Page 31 of the link in my first post make it clear that insurance carriers may offer plans both inside of the Exchanges and outside of them.

To repeat parts of the quotes in my first post:

... nothing in the law prohibits qualified individuals, qualified employers, and insurance carriers from participating in the health insurance market outside of exchanges.

An issuer may offer QHPs outside of exchanges as well as inside, but the premiums would have to be the same, even if the QHP is sold through an insurance agent.

That seems pretty clear that any carrier can offer plans through the Exchange, and other plans outside the Exchange - as well as offering the same plans for the same price both inside and outside the Exchange.  But stay tuned ... perhaps that is an incorrect interpretation.  I'm sure we will soon find out.

rdmoore2003

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Re: Insurance Outside the Healthcare Exchanges?
« Reply #6 on: October 03, 2013, 02:23:02 PM »
I thought this was to be affordable....For just myself, a minimum monthly premium of $500 with $5000 deductible & $7500 oop.   How is this affordable?
Regina

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Re: Insurance Outside the Healthcare Exchanges?
« Reply #7 on: October 04, 2013, 03:38:09 PM »
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To repeat parts of the quotes in my first post:

... nothing in the law prohibits qualified individuals, qualified employers, and insurance carriers from participating in the health insurance market outside of exchanges.

An issuer may offer QHPs outside of exchanges as well as inside, but the premiums would have to be the same, even if the QHP is sold through an insurance agent.

That seems pretty clear that any carrier can offer plans through the Exchange, and other plans outside the Exchange - as well as offering the same plans for the same price both inside and outside the Exchange.  But stay tuned ... perhaps that is an incorrect interpretation.  I'm sure we will soon find out.

Sorry I didn't answer this sooner and I meant to revise that part of my post.  YOU can go OUTSIDE the exchange on the private market, however, to get the tax credits you can only do that (if qualified income wise) through the exchange plans.  TO Get those credits if qualified you have to go through a plan ON the exchange through the carriers that participate with that exchange. Unless I am misunderstanding your question.   For example, if you live in a state where Aetna is not participating in the exchange, you can still buy insurance through Aetna but you will not receive the credits.    If you go through a carrier that is not offering underwriting of plans in that state then you won't get the credits but they still have to meet the ACA minimum standards.   A question to ask if I'm understanding you properly is : Why wouldn't you want to purchase on the exchange in that situation your cost is going to be lower (after tax credits). IF you don't qualify for tax credits than basically it's your choice.. you can still shop premium rates and you might find it cheaper on the exchanges.

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I thought this was to be affordable....For just myself, a minimum monthly premium of $500 with $5000 deductible & $7500 oop.   How is this affordable?

LOL do you really want to get me started on this?? It is along the same lines as to why I refuse to call this "obamacare" and when someone asks me (anyone) how Obamacare is going to effect them I say "It won't because there is no such thing as Obamacare".    You really don't want to get me started on this topic. LOL
Linda Walker
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