Anybody getting health insurance through exchanges?

[caligas]

Im on my groups health policy this year, but it's very expensive. A few younger partners used the obamacare exchanges. Anybody here had success?

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[deleted162650]

Im on my groups health policy this year, but it's very expensive. A few younger partners used the obamacare exchanges. Anybody here had success?

Ya, I've had an exchange Bronze plan (Anthem Blue Cross) for 2 years now. My prior group did not offer any group policy. Plan has been OK. For my family of 4 I pay $720/mo. in premiums. Deductible is high though - like 5 or 6K with a max OOP of 12 or 13K.

Keep in mind that under MaobamaCare your individual health insurance premiums are no longer tax deductible if you are eligible to participate in any form of employer sponsored/group plan. When you factor that in you may be better off paying more for the group plan since it would be with pre-tax dollars.

If you're single though the exchange may come out way ahead.

 

[caligas]

Ya, I've had an exchange Bronze plan (Anthem Blue Cross) for 2 years now. My prior group did not offer any group policy. Plan has been OK. For my family of 4 I pay $720/mo. in premiums. Deductible is high though - like 5 or 6K with a max OOP of 12 or 13K.

Keep in mind that under MaobamaCare your individual health insurance premiums are no longer tax deductible if you are eligible to participate in any form of employer sponsored/group plan. When you factor that in you may be better off paying more for the group plan since it would be with pre-tax dollars.

If you're single though the exchange may come out way ahead.

I take the self employed deduction for health premiums. Loosing that would kill any advantage of the exchanges, I bet.

 

[deleted162650]

OK gotcha, so you're 1099. I'm W-2 at my gig, but I still have some 1099 income coming in in the form of residual collections from my previous gig. My accountant told me I cannot deduct my premiums now despite the 1099 because I am eligible for the group plan with my new employer. The group plan is about $300 more per month than my individual plan. I still need to crunch the numbers and see what makes more sense.

 

[aneftp]

Ya, I've had an exchange Bronze plan (Anthem Blue Cross) for 2 years now. My prior group did not offer any group policy. Plan has been OK. For my family of 4 I pay $720/mo. in premiums. Deductible is high though - like 5 or 6K with a max OOP of 12 or 13K.

Keep in mind that under MaobamaCare your individual health insurance premiums are no longer tax deductible if you are eligible to participate in any form of employer sponsored/group plan. When you factor that in you may be better off paying more for the group plan since it would be with pre-tax dollars.

If you're single though the exchange may come out way ahead.

Yup. The same plan u have pre ACA on the individual market (I carried my own health insurance for a long time) would have cost around the same in terms of premiums. But my absolutely max out of pocket back in 2013 was $6000 with $700/month premiums for family of 4. HSA max out of pocket $6000.

That's why all the smoke and mirrors about premiums not going up. But the same plan has double the max out of pocket expenses.

 

[Chloroform4Life]

You get what you pay for. I didn't know better and got a cheap Obamacare plan (i'm 1099). Paid like 500/mo for me and the wife. Wife had a baby, and now we have to pay >$8,000 OOP.

To make it worse, I didn't know the anesthesia group that employed me don't accept the insurance I have, so her $1,800 epidural isn't covered at all. Going to be hard asking for a discount since I'm leaving and have given notice....

 

[caligas]

Ya, I've had an exchange Bronze plan (Anthem Blue Cross) for 2 years now. My prior group did not offer any group policy. Plan has been OK. For my family of 4 I pay $720/mo. in premiums. Deductible is high though - like 5 or 6K with a max OOP of 12 or 13K.

Keep in mind that under MaobamaCare your individual health insurance premiums are no longer tax deductible if you are eligible to participate in any form of employer sponsored/group plan. When you factor that in you may be better off paying more for the group plan since it would be with pre-tax dollars.

If you're single though the exchange may come out way ahead.

OK gotcha, so you're 1099. I'm W-2 at my gig, but I still have some 1099 income coming in in the form of residual collections from my previous gig. My accountant told me I cannot deduct my premiums now despite the 1099 because I am eligible for the group plan with my new employer. The group plan is about $300 more per month than my individual plan. I still need to crunch the numbers and see what makes more sense.

Technically, as best as I understand, I am a partner and owner of 2% share of our S Corp, which allows me to deduct the premiums, as long as I don't have access to a "employer subsidized plan." Our premiums come out of post tax dollars. So I actually get a w2 and a K-1, not a 1099, but I suppose that doesn't matter in regards to the health premium issue. Wow, I'm confused just reading what I wrote.

 

[deleted162650]

Wow, I'm confused just reading what I wrote.

OK good, glad it wasn't just me.

I didn't know the anesthesia group that employed me don't accept the insurance I have, so her $1,800 epidural isn't covered at all.

Wait, so your own anesthesia group charged you full price for an epidural. That's the coldest thing I've ever heard. Not only does my group not charge our own members, but we typically will work out insurance only deals for any other doc in the hospital. Glad your leaving cuz that's the biggest red flag most F'd up thing I've heard in a while.

 

[nimbus]

we typically will work out insurance only deals for any other doc in the hospital. Glad your leaving cuz that's the biggest red flag most F'd up thing I've heard in a while.

Isn't this illegal? We've been told this is an illegal inducement to use our services, even if we are the only anesthesiologists at our hospital.

 

[deleted171991]

Isn't this illegal? We've been told this is an illegal inducement to use our services, even if we are the only anesthesiologists at our hospital.

If those docs have no impact on the anesthesia contract negotiations, I don't see the inducement.

Whenever possible, I will not bill a fellow physician for my services, and I will go extra 10 miles for him/her.

 

[aneftp]

For us docs, it expensive but we can "afford it"

The common people with smaller employers who offer poor health insurance (barely ACA compatible). Those people are royally screwed.

Imagine making $40k a year with employer. Many smaller employers will only subsidize the employee and not the non working family members (kids, non working spouses).

I had worked at as a contractor at a smaller ASC and employer subsidized EMPLOYEE 80% but 0% employee families. And employee portion was only $150/month with a $1500 DEDUCIBLLE. But if nurse wanted to add kids. The premiums jumped to $800/month with a $6000 deductible.

Normally that single nurse would be eligible for tax credits under the ACA since she has kids and makes less than 400% of poverty.

But ACA doesn't require employers to subsidize employee families members. And since nurse is employed and employer offers health coverage.
That nurse cannot get ACA exchange rates which would have much cheaper after tax credits.

The ACA is full of holes that hasn't been fixed.

 

[deleted162650]

Isn't this illegal? We've been told this is an illegal inducement to use our services, even if we are the only anesthesiologists at our hospital.

Maybe it's different when you don't hold an exclusive contract?? Or maybe what we do is technically a no-no but nobody cares??

 

[urge]

Hard to believe that I'm subsidizing a lot you via ACA taxes.

Parasites.

 

[urge]

Isn't this illegal? We've been told this is an illegal inducement to use our services, even if we are the only anesthesiologists at our hospital.

Highly.

 

[caligas]

Seems to come down to referrals:

http://www.kevinmd.com/blog/2011/09/professional-courtesy-physicians-trouble.html

 

[urge]

Maybe it's different when you don't hold an exclusive contract?? Or maybe what we do is technically a no-no but nobody cares??

Nobody is smart enough to care.

 

[nimbus]

If those docs have no impact on the anesthesia contract negotiations, I don't see the inducement.

Whenever possible, I will not bill a fellow physician for my services, and I will go extra 10 miles for him/her.

Its perfectly legal to volunteer/donate your services to any patient you choose. So not billing a fellow physician is perfectly acceptable. What's not legal is to bill the insurance company and waive the patient's co-pay. You need to waive the entire bill.

 

[Wiscoblue]

I do send a bill to my partner or physician friend. But then I tell them not to pay it. I then tell my billing office to write it off as a financial hardship so we don't send them to collections.

We are already getting hosed by insurance companies. I have no intention of leaving any money on the table, or having them benefit from my generosity toward my partner or friend.


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[urge]

I do send a bill to my partner or physician friend. But then I tell them not to pay it. I then tell my billing office to write it off as a financial hardship so we don't send them to collections.

We are already getting hosed by insurance companies. I have no intention of leaving any money on the table, or having them benefit from my generosity toward my partner or friend.


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Sounds reasonable but there is a problem with it:

http://www.medicalbillingstudycourse.com/tips/truth-about-waiving-copays/

 

[Ronin786]

Sounds reasonable but there is a problem with it:

http://www.medicalbillingstudycourse.com/tips/truth-about-waiving-copays/

My dentist (and many out there) do that all the time. It's illegal, but that's his problem and I appreciate the free dental care.

 

[deleted171991]

Sounds reasonable but there is a problem with it:

http://www.medicalbillingstudycourse.com/tips/truth-about-waiving-copays/

Generally if the professional courtesy is the waiving of the entire fee or a percentage of the entire fee it is considered legal. However, if the professional courtesy is waiving the co-pay or the patient responsibility it is generally considered illegal especially if the patient has a federal insurance plan such as Medicare. This is true even if the patient is a physician.

So the best way to do it is not to bill them at all. That is not illegal. That's basically what I used to do, when we were paper-based (much more difficult with EMR systems), and that's what my surgeon colleague did for me. The next best is to waive a percentage of the fee; unfortunately, that can cause a precedent with the insurance company at contract renewal time.

 

[deleted171991]

I do send a bill to my partner or physician friend. But then I tell them not to pay it. I then tell my billing office to write it off as a financial hardship so we don't send them to collections.

We are already getting hosed by insurance companies. I have no intention of leaving any money on the table, or having them benefit from my generosity toward my partner or friend.


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Unfortunately, this seems to be considered fraud. You need to document the patient's financial hardship.

If you don't want to leave money on the table, you'll have to explain your friend why you cannot make an exception, legally.

Welcome to crony capitalism. This is not a free market. The rules are written by the insurance companies. Who else can pay half million-dollar consultant fees per speech to a "retired" politician?

 

[Wiscoblue]

Thanks. That's very interesting. We might have to review with our billing people.

The other option is to send in our bill after a month or so. That way the hospital and surgeon's bill has been used up for deductible and we don't have to deal with the issue of copay.


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[deleted162650]

Seems to come down to referrals:

http://www.kevinmd.com/blog/2011/09/professional-courtesy-physicians-trouble.html

Well that article makes it sound like the law only applies to Medicare/Medicaid patients and not privately insured patients. Even for government pay patients it's only illegal if it's done in a manner to influence referral patterns which it clearly is not in our situation.