[S]he bought [a] plan and was approved on Nov. 22. Because by January the plan was still not showing up on her online Humana account, however, she repeatedly called to confirm that it was active. The agents told her not to worry, she was definitely covered.
Then on Feb. 12, just before going into (yet another) surgery, she was informed by Humana that it would not, in fact, cover her Sandostatin, or other cancer-related medications. The cost of the Sandostatin alone, since Jan. 1, was $14,000, and the company was refusing to pay. (WSJ)
Actuarial studies of plans sold through health insurance marketplaces in some states found that many make consumers responsible for as much as 50 percent of the price of specialty drugs, which can cost $8,000 or more a month…
Researchers also say the higher rates help insurers bankroll low monthly premiums to attract healthy young enrollees…
Obamacare caps those expenses at $6,350 for individuals and $12,700 for families. But patient advocates say the spike in cost-sharing means chronically ill people could reach those caps quickly, in some cases within the first months of coverage. (Reuters)
Premiums for 2014 individual plans sold by eHealth, the nation’s largest private insurance exchange, have spiked by more than a third since coverage requirements under the Patient Protection and Affordable Care Act took effect. For family plans, the increase is more than 50%, the Mountain View, Calif., company reports. The average monthly premium for individual coverage purchased through the company’s website was $274. That was up from an average monthly premium of $197 for individual plans that did not have to adhere to new coverage requirements under the ACA. For family coverage, the average monthly premium for 2014 plans sold through eHealth was $663 a month, compared to $426 for non-ACA compliant plans. (Modern Healthcare)
ObamaCare treats immigrants better than U.S. citizens:
At issue is a little-noticed provision of the federal health law that allows some low-income immigrants who are living here legally to qualify for subsidies to help them buy private insurance through online marketplaces.
Poor U.S. citizens aren’t eligible for those subsidies because the law provided for an expansion of Medicaid to help them get coverage. (KHN)
After an hour on the phone, most of which was hold time, a call center employee had entered the several pages of information (names, dates of birth, addresses, etc.) into an application on her computer twice without success. She suggested that it might be something to do with the fact that our street address has the word “North” in it, which could confused the system if it wasn’t entered to exactly match the records they had received. (So was it N? Or North? Or NORTH? So many options!) We consulted the company benefits office, which advised us to enter everything in all capital letters…
Three hours after beginning my second attempt, I succeeded, or so I thought. DC Health Link congratulated me on my enrollment and I thought a health insurance card would be making its way to my door soon…Once again, that assumption was incorrect. When we hadn’t gotten any information on our new health insurance plans by February 3, I called our new insurance company and see what was up. They said they had no record of our enrollment…
Eventually my family got a letter that did confirm our enrollment. While the letter confirmed that we had enrolled in something, it did not explain why our insurance company didn’t know who we were three days into the month our coverage was supposed to start. (More)
Researchers with consulting firm Avalere Health found that 59 percent of silver-level plans on the new exchanges charge policyholders a percentage of the cost of specialty drugs rather than a fixed copay. Twenty-three percent of these plans have co-insurance rates of 30 percent or more of the cost of the drugs on the highest formulary tier, the analysis found. This rate increased to 60 percent among the lower-premium bronze plans, researchers said. The findings indicate that some patients will face higher or unexpected out-of-pocket costs on the exchanges when it comes to paying for specialty drugs. (The Hill)