Juror Number One – What say you?

With not much else to do and with a great need to avoid the CNN blaring in the Jury Waiting Room, I spent my time pouring over the first concrete result of ObamaCare received in our agency.   The results leave me with a very screwed up look on my face. (no jokes)

We need to hear from the entire jury to even begin to reach a verdict.   What I am posting below is an actual set of results from a mid sized employer group plan.   The rates pulled represent different age categories and family combinations.   This one company is different from the rest of the market because the physician list DOES NOT change.   It will be interesting to see the first set of real numbers from a standard PPO or HMO.

The result is a clear reduction in coverage with rates going -/+ 25%!    Assuming the same rate basis, the rates would have been much higher if they had not reduced the benefits.  Frankly, this makes absolutely no sense.  Although I expected this carrier to look good, I did not expect this result.

Those of you who understand the rate compression rule of 3-1 from ages 19-64, would know that we expected to see older folks getting the best result while the under 30s should get increases.  What we have here makes no sense.   The only explanation is going to be found in the drug formulary, lab and specialty drugs.   I have not made that comparison yet.   Without a actual Summary of Benefits and Coverage, I can’t make a final ruling from this juror.

I submit Exhibit 1 for you perusal:

Before ObamaCare After Obamacare
 Contract 8-1-2013  January 1, 2014
Plan A 2013 ObamaCare version Plan A 2014
Plan Type Staff Model HMO Staff Model HMO
Office visits $30 $30/$50
Co-Insurance none none
Annual Max Risk Per Person $3,000 $6,350
In Patient Hospital $400 day $600 day
Prescription $10 gen/ $35 Brandafter $250 $19 Generic $50 Brand
Age 37 $289.00 $350.00   ^
Age 45 $372.00 $408.00  ^
Age 54 $485.00 $604.00  ^^
Age 24 $261.00 $283.00  ^
Age 45 with 2 children $707.00 $547.00  v
Age 48 with Family $1,130.00 $1,066.00  v
 result Lower benefits – Higher Rates Prevail

You may be wondering if I rigged this comparison.   I did not.   In a previous Blog I explained how insurers will MAP or CHOOSE one of the new ObamaCare plans for your renewal.  This must be done for all non-grandfathered plans because all plans must be canceled at their 2014 renewal.   The insurer chose this new plan.

I look forward to receiving and reviewing the details hidden within this plan to see where benefits have been reduced or enhanced.

I hope to bring you some examples for the national small business insurers shortly.

About Paula L Wilson, RHU, REBC

Insurance and Employee Benefits, business owner, wife, mother, grandmother. Specializing in Employee Benefits, Personal Life, Disability and Long Term Care Insurance. Registered Health Underwriter, Registered Employee Benefit Consultant, Past President Orange County Association of Health Underwriters 1991, Past Vice President California Association of Health Underwriters, Past Legislative Chair of the National Association of Health Underwriters. Recipient of the Provencio Award for Excellence and Leading Producer Roundtable Award Recipient View all posts by Paula L Wilson, RHU, REBC

2 responses to “Juror Number One – What say you?

  • anne kelly


    • paulalwilson

      I did!

      Paula Health Care Reform Updates – Follow me on Twitter @PLWPIC

      NEW! Listen to the Latest Health Care Reform Update Here

      CLICK HERE to Shop for Individual and Family Medical Plans Paula L. Wilson, RHU, REBC Paula L. Wilson, Inc. P. O. Box 892740 Temecula, CA 92589-2740 951-694-1009 888-447-2852 fax 951-694-8735

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