Under Obamacare, Can Insurance Co. Raise my Premium Next Year if They Paid Out Large Claims this Yea

[tins]

if I get sick and my health insurance has to pay the hospital a lot of money,
my health insurance premium will go up next year as well?

Even if you are perfectly healthy and do not see a doctor a single time, your premiums are going to go up quite a bit due to the way obamacare is set up.
Healthy young people were supposed to offset less healthy middle aged people. For some reason the healthy young people did not like this idea.

 

[badkitty]

It has gotten nothing to do with you. I am saying that "everyone's premiums will go up PERIOD!

Thanks! Yes, I understand that part. EVERYBODY will have their premiums go up no matter what. We all know the cause of that.

I'm just wondering if any previous claims will make it go up even higher for me?

(knock on wood) hope I never have to deal with that!

 

[kgmom219]

Oh goodness....

Are you asking in regards to an individual plan, small group plan, large group fully insured plan or self-funded plan?

There can be four different answers.

Assuming you are asking about an individual plan, with or without a subsidy, on or off exchange, and without regards to political commentary, the answer is YES.

Its HEALTH INSURANCE. It goes up every year. With or without a claim.

The average increase in Texas over the last 10 years has been 17% in the individual and small group market. That's Pre-ACA. If we see more than a 20% increase for 2015, I would be shocked.

And in Texas, BCBSTX (by far the largest individual carrier) sent out MLR refund checks in 2011 equal to one month's premium to their clients. In 2012, it was around 25% of one month's premium. That was not based on an INDIVIDUAL's actual claim dollars, but based on the entire pool of individual clients. It works both ways.

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Even if you are perfectly healthy and do not see a doctor a single time, your premiums are going to go up quite a bit due to the way obamacare is set up.
Healthy young people were supposed to offset less healthy middle aged people. For some reason the healthy young people did not like this idea.

Seriously? Then why did they go up every year before ACA?

 

[tins]

Seriously? Then why did they go up every year before ACA?

Is this for real? Do you work in the health insurance industry??

 

[Dave020]

I'm just wondering if any previous claims will make it go up even higher for me?

You cannot be singled out for a rate increase (or decrease) on individual health coverage no matter how larger your claims might be.

 

[badkitty]

You cannot be singled out for a rate increase (or decrease) on individual health coverage no matter how larger your claims might be.

Thank you. That's exactly the answer I was looking for.

Yikes... I think I finally understand why there are so many Obamacare-haters. :(
I never understood it before. After reading a lot of the posts on this forum, it
finally made sense to me.

 

[Dave020]

Thank you. That's exactly the answer I was looking for.

Yikes... I think I finally understand why there are so many Obamacare-haters. :(
I never understood it before. After reading a lot of the posts on this forum, it
finally made sense to me.

Obama Care is "community rated" meaning that similarly-situated individuals pay the same premium. A 45 year old in very good health pays the same as his/her 45 year old neighbor who has a 35 BMI, diabetes and smokes (in CA there is no smoker rating but it may be different in your state).

That would be the equivalent of giving the good driver discount to someone with a DUI and 4 speeding tickets.

 

[kgmom219]

Is this for real? Do you work in the health insurance industry??

23 years.

12 years as a broker

2 years working for a broker.

3 years as a UHC account manager

5 years at a PBM

They go up every year. Indy. Small Group. Large Group. ASO.

Once in a GREAT while, I have seen a pass. Other than that, they go up. Every year.

Just like my friggin car insurance! And I haven't had a claim on that in 20+ years.

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Obama Care is "community rated" meaning that similarly-situated individuals pay the same premium. A 45 year old in very good health pays the same as his/her 45 year old neighbor who has a 35 BMI, diabetes and smokes (in CA there is no smoker rating but it may be different in your state).

That would be the equivalent of giving the good driver discount to someone with a DUI and 4 speeding tickets.

Was CA not community rated prior to ACA?

 

[badkitty]

Obama Care is "community rated" meaning that similarly-situated individuals pay the same premium. A 45 year old in very good health pays the same as his/her 45 year old neighbor who has a 35 BMI, diabetes and smokes (in CA there is no smoker rating but it may be different in your state).

That would be the equivalent of giving the good driver discount to someone with a DUI and 4 speeding tickets.

I'm not sure if that's supposed to be good or bad?

I also belong to a national health insurance plan where 99.9% of the citizens
are required by law to enroll. Is that just as bad? Or is the risk spread out
more evenly?

 

[Josh]

I'm not sure if that's supposed to be good or bad?

I also belong to a national health insurance plan where 99.9% of the citizens
are required by law to enroll. Is that just as bad? Or is the risk spread out
more evenly?

"Bad" is a relative term.

The single largest reason why premiums are going up has more to do with the way the healthcare "system" is structured. There have been, to my knowledge, no efforts to contain costs or create a coordinated care model. Health insurance companies have developed very innovative solutions and been working on addressing these cost issues and Obamacare has been a HUGE step in the wrong direction.

If everyone was in the same risk pool in theory it would reduce cost. In application, it encourages wasteful and abusive utilization. I'm sure fraud is an issue too, but when the RX companies can throw darts on a board to decide what they'll charge for drugs with zero push back from consumers and when insureds will check five tire shops to get the lowest price on tires but would never shop the cost of their providers, the consumer are enabling the doctors to continue to charge whatever they'd like AND blame the insurance companies.