We're going to have to find a new Medicaid provider for Mara because hers is leaving the market, but she has automatic coverage as part of her adoption agreement so the qualifying part won't be difficult. I'm able to have Lee on my insurance and am lucky enough to have an employer who covers the tax hit for unmarried domestic partners.

the tax hit for unmarried domestic partners.

Jesus. It's a good thing we live in the greatest country in the world, otherwise this sort of thing would be maddening.

Maybe, probably? I'm now on the California Pre-Existing Condition Plan (asthma + history of depression is enough to make a 32-year-old uninsurable, apparently), which my parents are in fact paying for (the premium's not too bad, I guess, $230-something, but that's a quarter of my income right now). I guess that will sort of be obsolete once the pre-existing condition part of the law kicks in, right? I suppose I can dream about having a real job with real insurance by that point. I actually have an interviewy thing of sorts in two hours, but it's more of an informational interview. And now I need to go for a bike ride.

Good luck with the interviewy thing, trapnel.

FWIW, $230/month is a lot of money, even if it's a good bargain for getting ripped off for health care premiums.

$230/month is a lot of money, even if it's a good bargain for getting ripped off for health care premiums.

And, at that price, there is presumably a big fat deductible to be paid in the event that you actually require health care.

3: Have you looked into what your fair city offers the low-income? I don't know how they handle medications, and you'd almost certainly need to change doctors, but I think their programs right now would be decent care at a much lower price.

And you should definitely look into Medicaid at the end of the year.

I am fortunate enough to be employed at a company that provides insurance. And from comparing with other people, it seems like a generous plan. And it still cost me just over $3k when I ended up in the hospital last year.

I highly recommend avoiding getting an ulcer. If I had not had that coverage, it would have been roughly $11k per day, and the 2.5 days I was in would be something almost as bad as my student loans that I finally paid off a few years ago. Not to mention about $100/month in prescription drugs, apparently roughly forever. I'm going to be 40 in a few days.

All of which is to say, I will absolutely go on the plan if I end up losing this job somehow. I'm completely uninsurable on the private market at this point, and the ulcer is apparently not going away.

We have really good health coverage but hoo boy could I use some of that sweet sweet universal preschool. Our child care situation for next year has fallen into the crapper and we're throwing around differences of hundreds of dollars a month like they're nothing as long as we can find somewhere to leave the kids.

The California PCIP's in-network deductible is $1,500, with an out-of-pocket maximum of $2,500, a lot better than one would get with HDHPs. But they're using up the money faster now and just closed enrollment to new people.

I highly recommend avoiding getting an ulcer. If I had not had that coverage, it would have been roughly $11k per day, and the 2.5 days I was in . . .

Eek!

http://www.youtube.com/watch?v=QPKKQnijnsM&

This is probably in TFA, but worth thinking about again.

A big part of why I picked up my current job was due to my wife's uninsurability (due, basically, to being female). If something happens to my job, we'd probably look on the exchange for coverage.

When I was laid off in 2010, I used COBRA, which was okay but only covered me (instead of us both). It was during that period, shopping on the individual market, that I came to discover that a second X chromosome garners immediate rejection from most insurers.

I'm definitely expecting to look into the Exchanges when the time comes (which I guess would be at the end of the year, for a plan beginning Jan. 1). I'm currently a small business, i.e. self-employed, paying $450/month premium with $1500 deductible. Not even funny.

I'm at work now, though, so this is a drive-by comment.

To Minivet's 7.1, I want to add that our experience with a doctor's office that only takes patients on Medicaid or who have no insurance (plus I suppose also Medicare, though I don't know for sure) has been fantastic. The doctors and nurse practitioners are kind and motivated and seem to do at least as good a job as the doctors taking private health insurance that I've gone to on my own. Probably some of this comes from our being informed, middle-class advocates for the kids, but I've been very pleasantly surprised after hearing complaints from foster parenting friends in other parts of the country.

I will probably buy on the Exchanges, assuming Texas doesn't secede over the issue.

Health related question: Does anyone ever experience severe pain/cramping in their foot/feet after having the foot get cold during the night? It happens to me every once in awhile, and right now it's been going on for 3 days. Painkillers don't hardly work against it. My boss recommended soaking the affected foot in hot water with Epsom salts. Anyone else got a home remedy? I am reluctant to ice it, as cold was what caused it in the first place. It is very slightly swollen, but not discolored. Going to the doctor, where I hope to at least get a refill of 20 Vicodin, for all the good that will do me.

Maybe you have gout.

7: there's Healthy SF for uninsured residents, but I'm insured and think it's probably better to be, in case of catastrophic awfulness, at least so long as my parents are willing to cover that. PCIP is pretty good about (generic) meds, though there's a non-trivial deductible I have to hit before non-generics are covered; luckily Singulair recently went generic, which was the only asthma scrip I had that would have been an issue. The overall deductible is annoying, and has kept me from seeking out the kind of therapy that would probably be helpful for me (CBT / behavioral activation), but since I just got hit with a $400 bill for an x-ray on my knee that didn't show anything, I think I may just accept that I'm likely to blow past the deductible this calendar year, and just find a therapist that takes that insurance plan. The knee thing is a bit frustrating--the doctor I've seen a few times since I got on PCIP is clearly running a high-throughput, minimal-attention business-model, which was fine when I just wanted scrips for my asthma but isn't ideal for worrisome and lingering joint issues.

I can't think of any less politically appropriate disease for Natilo to get than gout.

I haven't had 17 happen (ask Cold Hand Pokey?), but to prevent your feet from getting cold and congested, have you tried bedsocks? *So* middle-aged and unstylish, but very effective. (Bedsocks being fluffy but extremely loose, so as to not cut off circulation.)

||
4: and thanks for the well-wishes. The interviewy thing went about how I'd expected it to, which is to say, I felt it was a waste of the other guy's time, but I'm not sure what else I could have done. Basically, he's the head of the SF office of a software consultancy, and they run a great apprenticeship program, one that would be ideal for someone like me. But I'm not ready for it yet: the website gives a clear set of requirements, and I meet none of them. But because a friend of a friend, a very well-connected developer/consultant who met with me two weeks ago and gave me a sort of pair-programming test, sent an introductory email on my behalf, saying he thought I'd be a great fit yadda yadda yadda, there wasn't any way to back out, even though I knew it would basically be, "well, go through the checklist, and when you're done, apply."

And I have another interview, because of another such introductory email, tomorrow, which I'm not looking forward to, especially since it somehow got turned into a lunch thing, and I really can't afford to be buying people lunch, but obviously I can't back out now, &c. &c. This other place is a small consultancy that just started up, so I suppose at least there isn't such an obvious "why are you here? read our website, do what we asked, and then get back to us" problem.

I was actually feeling fine an hour ago, immediately afterwards--it's a very concrete set of steps, which is good--but now I'm sort of overwhelmed by the crushing certainty that I'll let it slide, the way I've let the online programming classes slide over the last two months. I should have applied to devbootcamp back in November, but I still can't get past the whole "tell us why you're awesome" application stuff, and in any case their next open cohort isn't till summer anyway; if it were feasible, it would make much more sense to go right into the apprenticeship thing. (This connects to what I was saying earlier about how I really, really need to find a therapist who will help me with concrete life-functionality stuff.)

I was holding back tears for much of last night, and the feeling's back again now, but I'm in the office now, with plenty of marketing materials for this for-profit-publisher to proofread, so that will hopefully keep my mind off stuff for the rest of the day.
|>

I'm sort of overwhelmed by the crushing certainty that I'll let it slide, the way I've let the online programming classes slide over the last two months
Christ, I hate this feeling. Stupid brain.

Sorry, x.t, and what Eggplant said. I'm doing the same borderline weepiness because of also being sure I'm going to let things slide that I have before and ugh ugh ugh. I'm sorry.

Almost the only success I've had learning things outside of closely supervised, high personal feedback situations has been when it's necessary for some project that I'm actually interested in (and this also requires me to be energetic enough to actually act on that interest, which...). I'm sure you've already considered this sort of thing, but I thought I'd throw it out there.

25: yeah, that makes a lot of sense, but the problem is that nothing really interests me, except in a distant, detached sort of way. Anhedonia really sucks that way. For years now the only motivators I've felt have been fearful aversion, often extending to a fleeing from consciousness itself, and a thin sort of grasping towards instant gratification (often perhaps more accurately characterized as a thirst for distraction, and thus a special case of the first, too); neither of these motivates in the right way for a self-directed project.

Back to work.

Yeah, that's what I suspected. As long as I'm offering cheerfully unhelpful suggestions, how about a group project or study buddies? Can social forces substitute for your own lack of energy?

I was actually feeling fine an hour ago, immediately afterwards--it's a very concrete set of steps, which is good--but now I'm sort of overwhelmed by the crushing certainty that I'll let it slide, the way I've let the online programming classes slide over the last two months.

Ugggh, I know that feeling.

Question: for me this feeling is related, somewhat, to the feeling of, "I should have gotten in touch with so-and-so. I didn't, now it's been two months, and I'll feel like a schmuck if I call them after this long a delay, maybe I'll just forget about it and hope they contact me or I run into them sometime." In other words the feeling of, "if I were a person who was on top of things I would have dealt with this earlier. Dealing with it now means admitting, perhaps only to myself, that I am not a person on top of things, and that becomes a motivation to put it off." Does that describe your experience as well, or would you say it's a separate vicious cycle.

yeah, that makes a lot of sense, but the problem is that nothing really interests me, except in a distant, detached sort of way

I'd say that the solution is to involve another person -- have somebody who will occasionally ask you how you're doing on the project, but that seems likely to cause more pain than productivity in your case.

In the realm of "wild speculation" I wonder if you could set up a system which would require you to enter a short answer to the prompt, "what did you do about X today" each day. For most days the answer would be, "none" Perhaps that would also just be painful, but I wonder if that could be enough to break out of the binary ("making good progress"/"abandoned (for now)") and keep it as a low-level commitment each day?

17, 21. Sounds as if it could be gout, which I have had (I was 15 and only drank the occasional beer at the time, so shut up), but it isn't usually triggered by cold.

Also, I had similar symptoms more recently, but ongoing, not just a few days, which defeated medical science as far as putting a name to it goes, but eventually they just shot a load of cortisone into the foot, which relieved it for a while. It's settled down as a peripheral neuropathy, which is Greek for "your feet or hands are numb and we haven't a clue why, but we've got more seriously ill patients to worry about, so piss off." It reduces your mobility a bit, but you can live with it.

Oh, and I should clarify. I don't mean some sort of group work where you meet every now and then to check each other's progress and decide on new assignments. I mean literally working on something with someone discussing it in real time.

21: Yeah, sometimes I do just wear my puffier wool socks. That tends to irritate my skin a bit though.

20, 29: I do have gout, but this is fairly different -- feels like the muscles in my instep are what's messed up, not the joints at all. I'm wondering if it could be some other kind of arthritis-y thing.

I sure wouldn't mind some cortisone shots. For my back too. I think the doctor said he would have to schedule an MRI first before he could do that.

I want to add that our experience with a doctor's office that only takes patients on Medicaid or who have no insurance (plus I suppose also Medicare, though I don't know for sure) has been fantastic.

I'm curious, what kind of provider is this, community clinic, private practice, for-profit corporation, or something else? Doctor's office implies the second, but I wasn't aware such practices had the margins needed to see many uninsured patients, although it looks like your state's Medicaid rates to doctors are higher than mine.

Question: for me this feeling is related, somewhat, to the feeling of, "I should have gotten in touch with so-and-so. I didn't, now it's been two months, and I'll feel like a schmuck if I call them after this long a delay, maybe I'll just forget about it and hope they contact me or I run into them sometime." In other words the feeling of, "if I were a person who was on top of things I would have dealt with this earlier. Dealing with it now means admitting, perhaps only to myself, that I am not a person on top of things, and that becomes a motivation to put it off." Does that describe your experience as well, or would you say it's a separate vicious cycle.

Yes, this is absolutely my experience as well. Indeed, one of the things I've been putting off is sending a Christmas New Year's general well-wishing card to an old friend & ex of mine who recently got in touch (although I think her foreign service assignment is about to end, so the address I have won't be valid--still, I imagine that the state department is pretty good about forwarding mail). As you suggest, one aspect of the problem is that everything has become tied into deeply fucked-up and perfectionist neuroses relating to my sense of identity, which raises the stakes for every petty little item on the to-do list.

27, 28, 30: Group work / study buddies have been helpful in the past. I've tried (and failed) to set something up like that here, but should try again.

32: It's a non-profit with a lot of grant funding. Apparently about a third of clients have no insurance and pay on a sliding scale. They've partnered with a lot of great programs in the area for a homeless clinic and to get a grant that lets kids bring home a book every time they have an office visit.

If any of these suggestions help let me know and maybe I'll try them.

Hah. I do appreciate the support. Sorry for such an early threadjack.

OT, or maybe back on, but my wife and I are thinking about ditching insurance altogether (or mostly altogether) and going with a concierge service--MEDICINE, obviously--which is dramatically less expensive. We're currently paying almost as much as rent for only my wife and daughter, I'm living on the edge by being uninsured. Coupled with more-than-rent daycare expenses (which will go away this year when the kiddo goes to public school), we could get back a nice chunk by doing the subscription doctor thing.
Secondly, why are Alaska and Hawaii's poverty limits so much higher than the mainland's in that chart?

Apparently about a third of clients have no insurance and pay on a sliding scale.

Ah, VTSOOBCing, they're an FQHC - so probably not just grants but also extra-high payments for Medicaid visits to help subsidize uninsured care.

Ah crap. I'm pretty sure there's an answer in here, but I'm too lazy to find it: http://bit.ly/YuxUeT

violating the sanctity of off-blog communication

And I have another interview, because of another such introductory email, tomorrow, which I'm not looking forward to, especially since it somehow got turned into a lunch thing, and I really can't afford to be buying people lunch

Did you explicitly set it up so that you'd be paying? I'd expect in a situation like that for the interviewer to pay.

I should have gotten in touch with so-and-so. I didn't, now it's been two months, and I'll feel like a schmuck if I call them after this long a delay

This weekend, I found some un-sent thank you notes from my wedding. I took a picture of one and sent it to a friend, who was delighted to learn that she had actually gotten us a wedding gift, which she didn't think she had.

Another one was to an old family friend who, in the time since I wrote the note, had died.

38: Yep, an FQHC. I hadn't realized the designation meaningfully changed their Medicaid reimbursement rate. They also don't advertise their funding status to patients, so I only knew anything because I'd looked it up. Our uninsured neighbors at the old house thought their rates for medical and dental care were reasonable, which I thought was reassuring.

I think the impact on the Medicaid reimbursement rate is a constant nationwide, but I probably don't have the knowledge to assert this definitively.

FQs are required to have sliding scales for uninsured, though.

NMM to Hugo Chavez.

Natilo, I sometimes get foot-muscle cramping in my arches, but it doesn't have anything to do with cold for me (if anything, just nervous spasms gone painfully haywire, as sometimes happens). I've usually treated it with hot baths, soothing genre fiction, and on occasion, upping my potassium intake.

I am suddenly on a roll with work, trapnel! Let's find a place to hang out and work together so we don't fall back into the void! Hoo-ah!

Worried about Venezuela. Blech. My university has pots of money sitting around for anyone wishing to conduct research there, and I would have a semi-legitimate scholarly project to undertake with the money, but I get jumpy even thinking about it.

45: For those keeping score -- Castro, Mubarak, Sharon -- still alive, if not, exactly kicking.

Did you explicitly set it up so that you'd be paying? I'd expect in a situation like that for the interviewer to pay.

No, I didn't--it was supposed to be coffee, but then we were trying to coordinate on times, and he said "lunch would work", so I said sure (since having it during my lunch break would be ideal), forgetting that, oh, right, for people with real jobs, "lunch" means lunch at a restaurant rather than snacking on a Clif Bar or a pack of almonds. I asked the friend who connected us for advice on proper etiquette. I'm not worried; it's really not a big deal.

46: Yeah, I've had arch cramps too, but this is more the instep -- kinda radiating out from the central, midpoint area.

50: plantar fasciitis?

On the OP, I was curious why Minivet raised the question of shopping the health insurance exchanges *now*: surely it is too soon? When's the possible open enrollment period for my state?

I found healthinsurance.org for a start. Note the boxed grid there on the middle right going to information about the position of various states on the setting up of an exchange; also links in the right-hand sidebar to handy phone numbers and email addresses to contact your legislators to voice your views. The 'more links about' section at the bottom of the main text is helpful.

I discover, for example, that MD's exchange is dubbed the Maryland Health Connection: going live in October 2013.

Texas of course is letting the feds do the work. At the bottom there we find the Texas Dept. of Insurance's page on, roughly, what the feds might do for you:

A federally-created marketplace is scheduled to begin open enrollment periods for individual and small employer coverage in October 2013, for coverage beginning in January 2014.

I have link fatigue now, but bottom line: if you're interested in your state's exchange, it looks like October is the time to get moving.

Reflecting on this, I am nervous: with a pre-existing condition, I'm normally uninsurable. The only reason I have coverage now is that I've been continuously insured since, well, forever. They can't deny you in that case, but would be able to do so if you lapsed. Criminy.

The health insurance exchanges are obviously going to be in beta-testing, and I usually don't join up with things until they've ironed out their kinks. In this case, the consequences could be grim -- what happens if I walk away from the BCBS plans I've always been with, then want to go back?

More information is needed about the robustness of the new rule against dissing people with preexisting conditions. Do you have to get all legal on their asses? I guess I'll look, ahead of time, into the procedure for complaining to the authorities.

It didn't cover preventative physicals or dental or vision, and I don't know what mental health benefits there may have been, but the standard insurance plan in British Columbia when I left cost about $60/month for a single male in his mid-30s, no co-pays, and almost every hospital offering basic care would accept you. I broke my hand, got a cast, more than one CT scan, then later got plantar fascitis and had a few visits related to that and aside for the cost of an over-the-counter splint for my hand, paid nothing beyond the premium for all of that care.

I moved back to California and ended up on a plan with high co-pays, a relatively small network, limits on office visits and a premium of over $170/month. I suppose I should have used it for care, but never did. I'm about to move to an employer-subsidized plan now and it's a relief. I really should see a doctor sometime.

54.1: Geez, fa, what's your point? I am surprised that it didn't cover preventative physicals, though.

Secondly, why are Alaska and Hawaii's poverty limits so much higher than the mainland's in that chart?

Because they're much more expensive places to live.

I don't really have a point. It's just moving from plan to plan in the last year has made it very clear - as if we didn't already know - how fucked up our system is.

53: Check your email, parsi.

57: I know, I know! You don't have to rub it in!

I'm teasing. It's all I can do to remain calm when people say that $230/month is awfully expensive (I pay twice that).

I have great hopes -- crosses fingers -- for the ACA exchanges. I'm lucky to be in a good state.

I didn't say it was expensive for health care. I said it was objectively expensive.

And I forgot to mention that after the California insurer looked at my application, they upped the premium because of the then-still-going plantar fascitis.

Speaking of which, Natilo, do you have any heel pain? When I first started having pain in my feet, I felt a bit of pain in the arches, but mostly the pain was towards my heel. The cause was probably a big increase in walking in my incredibly worn shoes: I hadn't realized that I'd basically worn away parts of the insole.

Buying new insoles stabilized things with my left foot and then it improved to be more or less fine in a month, but my right foot kept getting worse until it started to fluctuate between hurting a lot when I first started walking but then feeling better after I warmed up and hurting so much I wondered if I should be walking at all. For a long time I wore a softer insole along with an additional soft heel cup. I eventually got new shoes which improved things briefly but then everything was more or less the same again. I definitely noticed things were worse when it was colder, and in the morning rather than the afternoon, and when I first started walking rather than after I'd been up for a while, but again it was more heel than arch pain.

It's apparently hard to diagnose plantar fascitis with certainty and it takes a long time to heal. I started getting foot pain in August 2011 and it was pretty serious all the way through the spring of 2012 and then slowly improved. I'm still not sure I can declare it gone now.

The second doctor I saw, who seemed to know the most and had a background in sports medicine and was once a competitive runner, recommended various stretching exercises, including one that worked the arch but which I find difficult to describe. Basically, you sort of flex your arch without lifting your toes or heel off the ground. You do this by kind of scrunching up your toes, but not actually curling them.

I don't know if it was the stretches, or the extended unemployment that kept me mostly off my feet for 3/4 of the year, that really helped me get past the worst of it.

60: Yeah, $230 still is expensive outright. I was in a similar position to x trapnel - my parents bailed me out. My field* has a structural bias towards people who can rely on parents and other sources of support - you see a lot of people saying, essentially, don't go into it unless you have someone or someones who can carry you for months - and I have to acknowledge that I've benefited from that and am basically part of the problem. No way could I have held on to the same type of job search - sticking mostly to within-field applications - for so long completely on my own.

*Not unlike many.

Hang in, Trapnel. We should get back to trying to cook. It is something.

Now that I finally have decent health insurance again I've been going to the doctor to check out various minor but worrisome issues that have been troubling me. So far nothing has been very serious, which is a relief.

Yeah, we might need an exchange over here. My job is also being co-owner of a small business, and while I haven't had to go coverage-shopping yet (the family being attached to a university for now), I don't like the numbers parsimon is quoting, and I also don't like what trapnel says about psychiatric history. I suppose it's like applying for an academic job and anything is an excuse to turn you down. As a stubborn man I historically never ever ever went to the doctor until we had our daughter and I started having to get flu shots and pertussis shots and pinkeye abatement.

So, gah. As a needy semi-prole I hope to benefit from the exchanges, and as a good social democrat I believe in their spirit. The fallout from the electronic health records act has made me dour (my understanding is no cost savings, a few software companies wrote the regulations by way of their lobbyists, my brother-in-law the doctor tells me how shitty the software is and how it requires everyone in his office to stay an extra hour at work filling the crap in, but please someone tell me if this is a wrong picture). I do not want the tendency of large organizations to fuck things up to fuck up Obamacare in California or elsewhere.

The fallout from the electronic health records act has made me dour (my understanding is no cost savings,

Patience! I submit that electronic health records are at a stage similar to where personal computers were in 1987, when Robert Solow famously quipped "You can see the computer age everywhere but in the productivity statistics." Networked electronic health records are *the* key missing ingredient to making population health care models work. And they are working, in isolated pockets. The future is here, it's just not evenly distributed.

a few software companies wrote the regulations by way of their lobbyists

This is wrong. The health wonks drove he policies, the software companies merely rode the wave.

my brother-in-law the doctor tells me how shitty the software is

Frequently true, though it is getting better.

it requires everyone in his office to stay an extra hour at work filling the crap in

The "meaningful use" regulations are admittedly a blunt instrument, but a necessary one to drag the old-fashioned physician practices into the digital age.

Now that I finally have decent health insurance again I've been going to the doctor to check out various minor but worrisome issues that have been troubling me. So far nothing has been very serious,

I hear at least a couple of times per week how the problem with our healthcare system is that healthy people like you run to the doctor unnecessarily at the first hint of a problem because, thanks to your comprehensive health insurance, you don't have enough "skin in the game". To date, I have not fatally stabbed any of these people, but I haven't really had a sharp object handy, either.

Well, while nothing has so far been very serious, some of these visits have in fact turned up non-trivial problems that definitely needed to be addressed. So yeah, keep an eye out for sharp objects.

66 is what I was hoping for, thank you. Ima drink my salutary kukicha and turn in.

I was curious why Minivet raised the question of shopping the health insurance exchanges *now*: surely it is too soon?

Yes, I wasn't expecting anyone to have experience yet, just identify themselves for later updates. The earliest for California is also October.

As a needy semi-prole I hope to benefit from the exchanges, and as a good social democrat I believe in their spirit.

I tout the exchanges as an option, and hope they work, but I don't think they come near any social-democratic ideal; they're pretty severely neoliberal. (To nitpick.)

I mentally composed an elaboration on 66 in the shower this morning. Before typing it in the comment submission form, I realized that, with another hour or two of work, I could turn it into a publishable article, so I wouldn't want it appearing first in a blog comment. Alas, knowing my level of ambition, this probably means it is condemned to never being written down.

||
Lord save us, they're calling the impending D.C. storm the Snowquester.
|>

That's fucking stupid.

65: As a stubborn man I historically never ever ever went to the doctor until we had our daughter and I started having to get flu shots and pertussis shots and pinkeye abatement.

Never ever ever going to the doctor may well mean that you have no recorded history of chronic health problems, which works to your benefit! (Though, importantly, this is all moot by the end of the year, what with guaranteed issue, i.e. no discrimination against those with preexisting conditions.)

Still I find it hilarious, in a bad way, that friends of mine in their mid-40s who never went to the doctor have been cleared for an individual health insurance plan (at half the cost of my own plan) with no trouble; for all we know, they've had high blood pressure for the last 10 years, but in the absence of any record of such, they're golden.

But as I say, this will supposedly matter not come January 1, or rather October.

please make this an orange action-post

Does one sign it, or just give a beep-beep?

I am reliably informed that the correct protocol is to bounce bounce bounce bounce bounce bounce bounce.

So what? I'm drunk.

Okay. So, there's "food everywhere, as if the party was catered". Does that mean the party WASN'T catered? Where did the food come from?

Pot luck, I guess.

Is it far, far too late to add content to this post about developments in the roll-out of health care exchanges, pending the launch of Obamacare? I hope not.

I got a call from my health insurance broker the other day explaining that there's an early enrollment period this year. The deal offered by my health insurance company is this:

Normally you renew your annual policy in December for the following year, but this year, if you renew your policy by the first week in September, to take effect December 1, you can lock in your premium rate for 12 months, to end November 30, 2014. You will not be subject to whatever rate changes may take effect on January 1, 2014 (due to Obamacare). If you agree to this, your rate will go up 8.763% effective December 1, 2013, but that's all, nothing larger than that come January.

Hrm. I thought that through for 5 minutes or so.

Here's what it means: the insurance company, Carefirst, is attempting to head off at the pass people who might be intending to shop on the state health care exchange. Enrollment via the exchange begins October 1. By extending an offer with an early September deadline, the company skirts by the possibility that a person (me) might be able to see what the actual offerings on the Exchange will be.

There's some fear-mongering going on here: we have no idear what our rates will be come January! Be afraid! Lock in your rate early! I find this insidious, and sort of confusing: they seek to keep people from joining the exchange ... which will reduce the number of people in its pool ... which will work against the very idea of making the exchange's pool work. Right?

In the end, I told my health insurance broker that in fact I expected to take part in the state's exchange, and might could be eligible for a subsidy, so I'll have to think about it. He's to be sending me a copy of the letter he has from Carefirst explaining all this.

Unless you have an unusually public-oriented insurance company, that sounds to me like they expect the exchange rates to be lower. Or that they're poor right now, I guess.

I wonder if, in the face of true mutual uncertainty and good will, there's a middle way... lock in now, and your rate will be halfway between X% and the exchange rate? I don't think that makes as much sense as the exchanges themselves, though.

Very interesting, thanks for the post. I could see that snookering some people. But the Exchange rates are already set in broad outline - here. It doesn't show the full scope of variation based on plan tier, age, income, or smoking status, but that can be approximated through the KFF calculator.

How does the rate they're guaranteeing compare?

Obviously the vast majority of people aren't going to look that closely, but it is interesting that they're basically lying by saying that the exchange rates for next year are unknowable.

Sorry, a friend stopped by unexpectedly, so I wasn't able to follow along on these comments.

My health insurance broker said he was advising basically everyone to take the deal,* since the rates come January were so unknowable. So yeah. It seems nefarious, not just for the prevarication, but ...

well, here's where I'm a bit confused: if people currently on individual or small business plans renew those for next year, are they basically on a separately-tiered (priced) plan from anyone who joins an exchange-based plan in October?

* Separate question: anyone know how health insurance brokers are remunerated? Do they receive a static salary, or are they on commission, as it were? (If I switch to an exchange-based plan, I will no longer be a client of this broker, for example.)

82: Minivet, thanks -- I don't have time at the moment to do rate comparisons. Will do later, definitely.

84: Although most of the relevant regulations apply to extra-Exchange plans as well (metal tiers, community rating, no preexisting condition exclusion), they can be differently priced, and be structured differently to the extent not regulated. Though your state has authority to approve or deny those extra-Exchange plan rates as well; I'm not sure if those decisions have already been made.

Following up on 82 in case anyone is interested in the comparison:

At my current premium rate of $527/month plus the 8.73% increase deal offered by Carefirst, my annual premium cost for 2014 would be $6,876.

According to the KFF calculator -- which is an awesome thing indeed, thanks so much, Minivet -- my annual premium would be $5,149. (That factors in, chiefly and importantly, age. I'm approaching 50, and pay more.) I myself would qualify for a subsidy which would reduce that cost by about 1/3.

I'm a little puzzled about the calculator, though, as it doesn't seem to account for which state I'm in.