I’ve Never Been This Busy: As ACA Marketplace Deadline Nears, Navigators Feel The Pinch

Kaiser Health News ^ | 12-5-2017 | Michelle Andrews

[spintreebob]

When Monica Spalding got the renewal letter from her health insurance company with premium details for the upcoming year, she couldn’t believe her eyes. The insurer estimated that the share of the monthly premium that she and her husband would owe for their marketplace silver plan would go up from the current $28 a month to $545.

She immediately called Sharon Barker, a health insurance navigator with Family and Children’s Service in Nashville, Tenn., with whom she and her husband had worked this year to buy a marketplace plan after relocating from California to take care of her husband’s ailing parents. They sat down with Barker at their local library and showed her the letter.

Barker helped them run the numbers to determine that their premium tax credit next year will be much higher than the insurance company’s estimate, more than making up for the premium increase. The couple’s share of the monthly premium for 2018 will actually go down, Barker showed them: from $28 to $0.

“That’s why we need these navigators,” Spalding said. “If I didn’t have Sharon, I would have just paid that increase.”

But with outreach funding tight, Dimick said, she’s worried about the people they’re not seeing. This year, many insurers raised 2018 premiums significantly to make up for the federal government cutting off reimbursements for cost-sharing subsidies that insurers must cover under the law.

Consumers who get federal tax credits to help cover the cost of their premiums won’t generally have to pay more out-of-pocket, because that subsidy should cover the difference. But, like the Spaldings, many may not realize that.

[spintreebob]

$28 per month to $545. No! the $28 in 2017 is after subsidy. The 2017 before subsidy was in the hundreds; the $545 is before the 2018 subsidy.

This is FAKE news but it really is just the problem of both the author, and the navigators not knowing how to do simple math... a failure of our education system.

Bottom line, taxpayers pay the increase. There is a lot of tears because the government doesn't have the money to pay the increasing subsidy amounts.

The real problem is that government regulations have driven up the COST rapidly. Ryancare, McConnellcare and ACA all focus on corporatist welfare to big Insurance, big hospital and big IT corporations. CVS is merging with Aetna to maximize the money it gets from the taxpayers via HHS/CMS.

We must address the cost side, which so far, Trump has only addressed around the edges.

[PGR88]

The massive complexity of Obamacare was planned as a feature. It makes the sheep more accepting of a simple single-payer system, and in the meantime, allows the crony-capitialist insurance companies that got into bed with Obamacare and the state exchanges to create large pools of profit in that complexity.

[Buckeye McFrog]

That right there is the hallmark of an essentially corrupt system.

[fwdude]

The senate version of the tax plan had BETTER be upheld with its revocation of the individual mandate. If it doesn’t, I might start my own political party.

[rktman]

So, here's some NOT fake news. Neither one of us is on the 'aca' system but Mrs rktman was being covered under my old employer health plan and i had private Medicare supplement. Our share of the old employer premium was going to go from $950/month to $1,016/month. We cancelled it and found another plan locally which is $703/month. Bigger copays and deductibles but hopefully if no one gets sick or injured, we can put some aside to pay the out of pocket stuff. I dropped my Humana Medicare supp and found a local one that is zero premium. Was $203/month and didn't see the increase before I cancelled it. So, like I said, if no body has a major malfunction we can, with some discipline, hang on to an extra $500/month. Since I get the majority of my care at the VA as a level 8 (means I agree to pay copays for docs and meds) I should be okay. Hopefully the copay for my neck surgery 3weeks ago doesn't do me in. Just saw the first invoice and it's over $90,000. It was a "Choice" program approved procedure so....... One night stay too. WHAT! 🤕😷🤒

[Presbyterian Reporter]

“””Hopefully the copay for my neck surgery 3weeks ago doesn’t do me in. Just saw the first invoice and it’s over $90,000”””

---

The amount billed by the hospital and/or doctors means nothing. The only number that matters is the amount allowed by Medicare.

I typically see doctor and hospital billings that are cut as much as 90% by medicare.

If other industries in the USA operated like the medical industry, there were not be enough prisons to house all the scoundrels.

Obamacare only made the medical industry more corrupt.

[rktman]

LOL! Yup. Looking at the summary is amazing as to the billed amount, the "allowable" amount and the accepted amount. Somebody is making something somewhere along the line. With the Humana plan I just cancelled, I paid more in premiums than they paid out in claims for the year when I did use docs/services outside the VA system. 💸

[48th SPS Crusader]

It makes the sheep more accepting of a simple single-payer system,

We have a WINNER!

[rktman]

Just checked the current statement and so far about $75 + k has been “adjusted”.