Costco Aetna Health Insurance now available in CA

User Forum Topic
Submitted by joec on February 19, 2013 - 6:06pm

Just wanted to get people's opinion if they have any on Costco now offering health insurance in CA through Aetna...

Wife had Aetna previously at a job and was ok with it. Currently use Blue Shield and think they are ok, but really expensive (we're self employed). I'm really also considering moving to a high deductible plan for myself since I rarely use health care and am probably considered healthy (non-smoke, not overweight, no real problems historically).

Can't say I really like how Blue Shield operates in general, but that's probably true for everyone about their health insurance company.

Thoughts and opinions? It seems our regular doctors are in the plan from their website so shouldn't have to change doctors neither, but figure I can bank a lot of money in these accounts instead of paying a higher premium...

Submitted by jpinpb on February 19, 2013 - 7:43pm.

Do you have a link? How much is the coverage w/Costco? What are the terms?

Submitted by spdrun on February 19, 2013 - 7:46pm.

If you own a small business or are sole proprietor, does Freelancer's Union have any plans in CA?

Submitted by Hatfield on February 19, 2013 - 10:53pm.

Interesting that you should post this now.

Costco used to offer individual health insurance plans through UHC/PacifiCare for its business members. I enrolled up in 2006 and am still with them today. About three or four years ago I received a letter stating that this program was no longer being offered to new subscribers, but UHC/Pacificare would continue to honor existing policies.

A few weeks ago I received a notice that UHC/Pacificare was terminating all individual policies at the end of this year. Apparently the California insurance exchange opens in October with policies starting the first of the year. So I'm going to be shopping for health insurance in the fall.

Submitted by joec on February 20, 2013 - 2:01am.

Here is the link about it, I put in my info and found only a few plans available so not sure if those offered are a good choice.

You can start here:

A link points to:

Also business health here as well:

This was just advertised in their monthly mag last month so was curious how good/bad this is.

Submitted by carli on February 22, 2013 - 10:45am.

Yep, I have recent experience with this. We applied for a quote on the Costco/Aetna individual (family) coverage as soon as it was available in late Jan, as our current policy through Anthem/BC renewed us for Feb 1st with a 28% increase (same increase I believe went to all individual policy holders). We only want high deductible health insurance to cover catastrophic care...we go into it knowing we're going to pay for all else out of pocket and just search for the lowest premium and highest deductible.

This year, we shopped it around by getting quotes from a broker, who told us that in his experience, the Health Net policies offered through the Farm Bureau (yes, you have to join the CA Farm Bureau to get them!) were currently the lowest cost. In addition to his Health Net quote, we got the Aetna/Costco quote so that with our Anthem/BC renewal, we had a total of 3 to compare.

For all 3 carriers, we went with their highest deductible plans, which were all $5000-$6000 per individual or $10,000-$12,000 for a family. We basically just compared the worst-case scenarios for each plan and took at look at our out-of-pocket maximums. Plans had minor trade-offs in coverage but all offered one full physical per year w/out incurring deductible or coinsurance but the rest was subject to deductible/coinsurance. I can't recall what the various prescription drug coverage options were, but very similar (I think all were subject to deductible/coinsurance).

So the way it turned out was that it was basically a wash between all three. The new Aetna/Costco plan was the most expensive, believe it or not, but I think it was only by about $40/mo.

For all these plans, you get a quick estimate up front, which usually looks decent, but then you have to spend quite a long time (especially if you have 4-5 in your family like us) filling out extremely detailed medical info for each person going back 5 full years in medical history (UGH!) and afterwards, the simplest issues can cause their underwriters to rate you up. One of our kids was rated up for infrequent visits to a dermatologist. She's a typical teen who wants to keep her skin flawless so she takes Retin-A to keep pimples at bay and they came back with a 30% increase in her rate with a diagnosis of acne. It's all so silly because with a $5000 deductible, the insurance company never pays out on any of these minor claims anyway, but you still have to report them, of course.

So in the end, it made most sense for us to just stay put...we could've saved $30ish a month to move, but in my mind, it's better to build a longer track record with one insurer as the underwriters do consider longevity of policy when they rate you in the future. Also, it's the old adage of staying with the devil you know versus going with the devil you don't know.

One more probably know this, but if you form an LLC or S Corp for any type of business and buy the insurance through the business, your rates will be substantially lower.

We're going to be interested in seeing what the new federal health care laws will bring next year for individual policies. Health care in our country is one of the biggest conundrums ever - seems almost too complex to solve for so many reasons (let's not even get started on that!)

Good luck finding decent options.

Submitted by joec on February 23, 2013 - 9:44pm.

Many thanks for your detailed experience. Yeah, I wasn't too impressed with the 5 plans offered which mostly looked exactly the same with different deductibles. On the positive, it looks like at least all of them had maternity which was actually really hard to search for last go around. I've also noticed a lot of companies don't even seem to want your business and you're right, individual plans are extremely expensive. It's really disappointing compared to what I've been used to 20-30 years ago.

We're probably going to move to an s-corp this year so maybe I will wait for that to happen before changing as it is time consuming.

I tried to get my son off my plan since they seem to want to charge him my rates even though he should be a lot cheaper. They wanted to do a full underwriting again and you have to complete all the paperwork, etc...again...just to split up the plan. It's like a land grab with these companies. It's probably not just them and the environment we are in in terms of health care, but it does really suck I think. I had a family member suggest we run all these mental tests when my son was really young and I shut that down because I was worried about what you mentioned as well...They might see something and just deny, raise premiums etc...

Sorta like making random or small insurance claims on a car or home, you really have to be wise with your health insurance too and avoid it if it's not a huge deal.

Submitted by spdrun on February 23, 2013 - 10:12pm.

Is there no way to get onto a group plan as a self-employed individual in CA, either through a "union"/"guild" or through a professional organisation of some type?

The detailed health-history bullshit makes me very thankful to live in a community-rating state, albeit one with pretty expensive insurance. Had some stomach problems a few months ago and wanted an endoscopy to rule anything bad out and check for hiatal hernia. Went in, got it paid for without risk of prejudicing future insurance ratings or any such nonsense.

Hoping that Obamacare will make things relatively straightforward for the rest of the US.

Submitted by njtosd on February 23, 2013 - 11:57pm.

A number of doctors I've seen don't accept Aetna. Haven't had that problem since switching to blue shield. Even if you have a high deductible, it's still a pain to report out of plan payments and you don't receive the insurers negotiated rates. We went to an HSA plan and so far, so good.

Submitted by carli on February 24, 2013 - 8:11am.


Yes, there are better/cheaper health care plans for those who are self-employed. But there are few options for those of us who retired early (before being eligible for Medicare) but haven't formed a business, or are still looking for employment after COBRA runs out, etc.

Also, I believe CA does have what's considered a community rated plan options but since that plan is the last resort for many, the community pool has become expensive and the broker told us it would be way worse than what we pay (just under $600/mo for a family plan w/deductibles around $5000/each or $11,500/family - no picnic but doable).

We'll see what Obamacare brings - could be more (due to richer mandated benefits and introduction of higher risk pools), could be less (due to having more people to spread the risk around). But, I'm a believer that something had to be done and his plan is a good first crack at it so kudos to him for making it happen, even if we do end up personally paying more than now.

Submitted by David J on February 24, 2013 - 11:19am.

I believe this is the official California site for the future plans:

Here is a PDF with some more details:

Submitted by bearishgurl on February 24, 2013 - 3:11pm.

It appears Joe C decided he wasn't interested in the Costco plan. From the looks of things, he's probably better off leaving "well enough" alone.

I've been an Aetna Advantage (PPO) member (HDHP) since 2004. I medically qualified thru their own salespeople in PA. I didn't use a broker.

I just had a chance to review my (HDHP) policy and it appears mine is *better* than Costco's "Preferred Network 5,500 Deductible Plan" (which it most resembles) in a number of ways.

These differences are for In-Network providers:

My Annual Deductible is $5K/$10K. Costco's is $5,500/$11K.

My Coinsurance Maximum is $3K/$8K. Costco's is $5K/$10K.

My Annual Out-of-Pocket Maximum is $8K/$20K. Costco's is $10,500/$21K.

My Emergency Room copay is $100 (waived if admitted). Costco's is $350.

My Generic pharmacy price is $15 copay (ded waived). Costco's is $15/$20 (at Costco only). I can fill mine anywhere at this price. (I've actually gotten them at $5 and $9 in the past, depending on what they were.)

My Preferred Brand pharmacy price is $35 copay (ded waived). Costco's is $30/$35 (after ded).

My Non-Preferred Brand pharmacy price is $50 copay (ded waived). Costco's is $40/$50 (after ded).

Here's Costco's Aetna brochure. Wait to load:

I also have this additional coverage (which may or may not be a part of Costco's plans - they don't state):

Urgent Care Clinic copay is $50 (ded waived).

Up to 30 days Hospice - 30% (after ded) $10K max lifetime benefit.

Routine Cancer Screening (as ordered by dr) - 100% (ded waived). (I've already had two colonoscopies pd for by Aetna as a cost of abt $2200 for both.)

Ambulance - 30% (after ded) $2K max annual benefit.

Organ Transplant - 30% (after ded)

Hearing Aid - $200 every 36 mos (ded waived)

The rest of my coverage is the same as that of the Costco plan.

Fortunately, I don't have to cover any dependents ... only myself.


Note that I am "grandfathered" into this policy. Even though my premium has gone up >12 times since 2004, I would be a fool to switch carriers until I am Medicare-eligible, at which time I'll buy a MC supplement and "Part D" prescription coverage (that is, IF MC is still around, then) :=0.

And I may not need to switch then, either.

It's interesting to see how my carrier has insidiously shaved benefits from their plans since the law has required them to accept any applicant, regardless of pre-existing condition. For many of these new applicants, the carriers obviously can't know in advance exactly what to charge them in premiums, due to the unpredictable nature of their ongoing medical bills. All they can really do is issue this subset of applicants a policy and "play it by ear" as to how much to raise their premiums every 6-12 months :=0

Submitted by bearishgurl on February 24, 2013 - 3:37pm.

David J wrote:
I believe this is the official California site for the future plans:

Here is a PDF with some more details:


I just ran the "Covered CA" calculator on myself and found that my premium with the "state pool" would be just $1 mo less than I am currently paying with a potential of nearly $5K more coming out-of-pocket annually!

This is no bargain for persons who are already covered by (grandfathered) individual policies.

My premium would have to be raised the maximum allowable over the course of a few years while the "Covered CA" premiums stayed flat in order to make it worth my while to switch (assuming I wasn't already MC-eligible, lol). I just don't see this scenario happening in tandem :=0

Submitted by UCGal on February 25, 2013 - 12:10pm.

David J wrote:
I believe this is the official California site for the future plans:

Here is a PDF with some more details:

Thanks for the links.

The calculator at the first link is good. It matches what the kaiser family foundation calculator estimates.

Note that the income is MAGI not AGI. (Includes some extra, normally tax excluded stuff)

Submitted by no_such_reality on February 25, 2013 - 2:25pm.

Ouch, that's pretty harsh. Family of 3 or 4 is $1149/month with $12,800 out of pocket. Medicaid carries until an income of $32,500. At $32,500, out of pocket is limited to $4500 (a lot if you make $32K) and you're premium estimate is $81/month.

At $47,100, out of pocket jumps to $10,400, premium running $247/month. At just before $59K you jump to $12,800 and your premium is still only $395/month.

Next cutoff is $94,200. At $94,201, your prior tax credit goes from $403/month to $0. Which corresponds to 400% of poverty level.

Submitted by dumbrenter on February 28, 2013 - 5:41pm.

this plan is for poor people

Submitted by bearishgurl on February 28, 2013 - 6:03pm.

dumbrenter wrote:
this plan is for poor people

I get the qualifications for Federal help to pay their premiums but what I DON'T get is how the average "poor person/family" is going to pay nearly $13K out-of-pocket if one of them just happens to land in the hospital.

They'll just end up getting a medical judgment lien against them. If they don't own any property, it will prevent them from ever buying any.

Medical providers are notoriously aggressive in collecting unpaid bills.

So what's the point? Right now, CA hospitals can't refuse to treat the uninsured. If they don't qualify for Medi-Cal, the hospital seeks "charity care" for them to pay some or most of their bill and then usually writes the rest off.

The "poor" who have no aspirations to buy RE don't really care about their credit ratings.

All the "CoveredCA" program is going to do is "spread the pain" of the low-income chronic medical-care users (not necessarily "sick") among the carriers who currently write policies in CA, who will in turn raise the premiums (again and again, as in the past) of their current individual policyholders who are "grandfathered" and thus "trapped." The vast majority of these policyholders had to "medically qualify" for their policies.

"Poor people" have no business using HDHP's, IMHO. But the only other alternative is to issue them more comprehensive plans similar to the Kaiser HMO model but "ration care" for them and who would decide what to ration? It's a slippery slope.

Submitted by earlyretirement on February 28, 2013 - 8:53pm.

I was just thinking about what other options are out there for healthcare coverage. I signed up with Kaiser Permanente 2 years ago. I own my own company so I self-insure my family. Prior to that I lived abroad and bought private medical insurance that was amazing! Expensive but really great and rivals anything I've had in the USA.

As with others, they keep raising the prices each year. We have a plan which covers my wife and I and our two kids. Keep in mind my wife and I are still fairly young and our kids are just 3 and 4. We pay almost $1,600 a month now for coverage.

When we first got it I thought they were pretty good. I liked the technology aspect of Kaiser where you take a blood test and you get emails instantly as each result comes back. It keeps track of all your prescriptions and you can order online. All your physical information is all online. Heck, you can even email with your doctor with them responding fairly quickly.

What I found about Kaiser is they are GREAT for preventative type stuff. Free immunizations for the kids. Free annual physicals, etc. But if you have any more serious type issue or have to get referred to a specialist they kind of drag their feet.

Plus when our kids are sick (nothing serious but just fever, flu, etc) they almost never can see their own physician who is really great. We almost always either get stuck seeing a nurse or some other random doctor as their doctor never can get them in besides annual exams, etc.

I'm lucky as though it's a small world, my primary care physician just happens to live down the street from me in the same development. So if I need anything he always gets back to me quickly.

We are young and healthy and mainly got it because we have young kids, and we plan on maybe having more kids and there weren't a whole lot of options out there. $1,600 a month ($19,000 a year) is quite a bit to pay for mediocre medical coverage.

It just doesn't seem like there are too many great options for individual coverage if you self-insure.

Does anyone else have any good options besides this Costco that they can recommend based on personal experience?

Submitted by spdrun on February 28, 2013 - 9:08pm.

Amazing -- doctors using e-mail :) Most of the ones that I've dealt with (including a professor of quite high repute who invented several new surgical procedures) have been awful technophobes when it came to digital communications.

This being said, they've always been quick to fit me in and schedule tests when needed -- no waiting for months for simple tests, as I heard happens in some places.

I'm not a fan of the HMO-does-everything-and-you're-fucked-if-you-want-to-go-out-of-network model of doing things.

Submitted by bearishgurl on February 28, 2013 - 11:29pm.

earlyretirement wrote:
I was just thinking about what other options are out there for healthcare coverage...

ER, you seem like you might be a good candidate for an HDHP.

$1600 mo seems high to me for an HMO for a healthy young family of four. But of course, I am not your underwriter.

I'm guessing, of course, but if you all are truly healthy, I would think you could get a ~11K/$20K ded HDHP plan for ALL of you for $600-$800 mo.

I don't know about the other carriers, but with Aetna Advantage, you can STILL get preventative health services for $0 (no copay/no ded). In CA, as of July 1, 2012, pregnancy is treated like any other medical issue . . that is, ins cos can no longer refuse to cover it.

This bill, commencing July 1, 2012, would require every individual
health insurance policy to provide coverage for maternity services for all insureds covered under the policy.
This bill would become operative only if AB 210 of the 2011-12 Regular Session is also enacted.



I even got a rate hike of $34 mo commencing July 1, 2012, with a nice letter telling me how I now have maternity benefits :=D

I just wonder who was helping to pay MY healthplan premium when I was in family-raising mode! Alas, it was likely no one but me and my employer :=0

With an HDHP, you certainly would have no problems seeing a specialist as there are no "gatekeepers" in PPO plans.

IOW, if you were diagnosed with cancer and wished to be treated by the Mayo Clinic in MN or the MD Anderson Cancer Center in TX, you would certainly be welcome to do so, without interference from your carrier. In addition, if any of these providers were "in network," you would receive the "in-network" benefit as opposed to the out-of-network benefit.

A big difference from your HMO would be $40 (PCP) and $50 (Specialist/urgent care) copays as your HMO copays are likely much less.

If you were a healthy family, you would have to go to the doctor 1-2 times per week, per person in order for your $1600 monthly HMO premium to really be worth it, IMO.

This is just my .02, for whatever it's worth to you, ER.

Submitted by earlyretirement on February 28, 2013 - 11:49pm.

Thanks so much BG. I will check out that option you mentioned. Appreciate the advice.

Submitted by bearishgurl on June 25, 2013 - 12:45pm.

I got a letter from my carrier yesterday that Aetna is leaving the individual market in CA on 12-31-13. They will return all CA applications for new policies still in their possession on 6/24/13. Apparently, they did not want to upgrade their CA HDHP policies to conform with PPACA standards to roll out on 10/1/13.

www calhealth net/Aetna_leaves_California_individual_health_market.htm

They will still write and service large employer-sponsored health plans in CA (employers of over 50 employees) and will be giving up approximately 49K (part of them "grandfathered") individual policyholders in CA, like myself.

I'm going to have to avail myself of the state-run "silver plan," and can hopefully qualify for a smallish tax credit to help pay for it. It's going to be about 65% more expensive than my current plan and have higher copays than I have, higher generic prescription costs and higher costs for tests and X-rays. Only it's OOP annual cap is lower, but only by $1600.

In any case, I cannot address this issue until CoveredCA rolls out the particulars after 10/1/13, i.e. which carrier for which plan (YES, there's a HUGE DIFFERENCE between carriers) and choice (or lack thereof) of providers.

It's time to finish scheduling whatever expensive tests I think I'll need for the next few years NOW as their costs are going to go w-a-a-a-ay up for me after 1/1/14.

Meanwhile, I got another $35 rate hike beginning July 1, 2013, (the 13th rate hike I've received since 2004, when I signed up).

I've gotta get my "money's worth" now, as I've been relatively "healthy" and haven't used much more than preventative services over the years.

Now, I'll be "lumped in" by age and smoking status ONLY on the state-run exchange with my "brethren," many of whom did NOT take stellar care of themselves over the years or had/have addiction issues which were/are, not surprisingly, now causing them major health problems. I won't be able to obtain a healthcare premium based upon my OWN health status and level of healthcare usage (which requires effort and diligence to maintain) ever again, unless the PPACA is somehow overturned.

The days of having to medically qualify for a healthplan and premium-level (as I did) are now OVER, folks.

I believe the original intent of of "Obamacare," FKA "Clinton-era failed healthcare-reform," was for the healthy to pay enough in premiums to subsidize the non-healthy. I don't have a problem with this, in theory, for cancer treatment for a deserving patient who is simply unlucky or to contribute to a program such as "Healthy Families" (CA low-income children's coverage) but SO MANY health problems in adults (including some cancers) are self-inflicted. This is why I believe every healthcare plan applicant should be underwritten individually. Otherwise, the "system" is VERY unfair to the disciplined vegetarians, tree-hugging yogis, gym rats and otherwise athletically-inclined individuals who have never had addiction problems.

Based upon the uninsured (by choice) with whom I've talked to, I don't think the healthcare reform mandate for coverage is going to be successful as there are no teeth in any laws to collect fines from those who don't comply with obtaining and keeping coverage. In addition, many residents of SD County have Sentri passes and go to MX regularly for medical/dental treatment and have done so for many years.

Interesting times we live in, folks :=0

I hope I don't have any big health issues next year and am able to obtain coverage with a decent carrier. Otherwise, there is just more incentive for the retired and soon-to-be-retired-but-still-under-age-65 group (of which I'm a member, lol) to leave the state in search of better carriers with better plans who are participating in state and Federal healthcare exchanges.

For example, if I am required by CoveredCA to pay ~$550 per month for some BS nearly-worthless plan run by "Health Net," I'm going sign up but be out of here as soon as I can, folks.

The providers in CA populous counties have got to be disgusted beyond belief that Aetna and CIGNA are not participating in the state-run exchange and that Aetna is leaving the state (exc for employer-sponsored plans). I guess these two giants want to stay alive until the initiation of the PPACA shakes out and the quantity and quality of the actual poor and sick (or just sick) new applicants is known.

Of course, all the other states will be watching the results of CA's exchange closely, as being the most populous state, CA is the "testing ground" for this debacle ... err ... experiment.

Submitted by SD Realtor on June 25, 2013 - 12:45pm.

From a strict financial standpoint, it would be foolish for a young twenty something to enroll in a plan. Simply pay the fine and walk away would make much more sense while somewhat more risky.

Submitted by bearishgurl on June 25, 2013 - 1:17pm.

I just noticed insurance giant United Health is also not participating in CA's state-run healthcare exchange. That's three giants and counting.

And I wonder who will bail out by the end of 2014, primarily due to overall quality of new sign-ups in Covered CA. It's going to be very interesting to watch. Whatever, the case, we are moving towards a monopoly on healthplan insurers in CA.

This does NOT bode well for keeping rates down going forward :=0

And I agree with SDR. If I was 20-something, otherwise "healthy," and not covered by a parent or employer, I would use community clinics (whose fees are on a sliding scale) and borrow unexpired prescription antibiotics occasionally from my friends and family before I paid $200 + month for a nearly worthless plan :)

This is ONE of the reasons why Obamacare's "theory" of the healthy insureds' premiums subsidizing the unhealthy insureds' premiums isn't going to work out well.

At that age, that money is better directed to a student loan or savings to buy a vehicle.

Submitted by outtamojo on June 25, 2013 - 1:35pm.

Left-over antibiotics? Don't you know that between one of you not finishing out your prescription and the other not getting a whole prescription you are helping to create resistant super-organisms?

Submitted by bearishgurl on June 25, 2013 - 1:40pm.

outtamojo wrote:
Left-over antibiotics? Don't you know that between one of you not finishing out your prescription and the other not getting a whole prescription you are helping to create resistant super-organisms?

outtamojo, that's kind of wacky. I though that only happened to people who overuse antibiotics.

In any case, LOTS of people have repeated refills left on common antibiotic prescriptions which they don't fill because they are "better" now and don't want to overuse antibiotics. Those refills could ostensibly be filled for your 20-something brother or friend who is uninsured and needs them.

Submitted by SD Realtor on June 25, 2013 - 2:06pm.

I think the monopoly you are referring to is a single payer system which has always been the non stated vision. These are the incremental steps to get there.
It couldn't be done in a single swipe back in 2009 but everyone knew that this would be the natural progression.

For all the engineers who think they are safe with the plans that their big corporate giants provide for them, in the long run it will be more profitable for these employers to opt out as well and turn all the employees over to the system.

Again, if you simply follow the path to highest returns for either the corporate entity or the healthy individual, dumping people into the system is the best alternative. In the long run the only alternative will be to have substantially higher penalties for those who do not opt in and for corporations or the system will break. Even without breaking, the system meanwhile will swell with millions of people each year (including those with fresh citizenship) and overall quality will diminish.

It is very simple, at some point the sheer numbers do not get supported given cost parameters, and the number of those contributing. The result is a ever lower bar that is the common denominator.

Submitted by no_such_reality on June 25, 2013 - 2:19pm.

bearishgurl wrote:
I just noticed insurance giant United Health is also not participating in CA's state-run healthcare exchange. That's three giants and counting.

The state's four largest health insurers -- Kaiser Permanente, Anthem Blue Cross, Blue Shield of California and Health Net Inc. -- were all selected.

Frankly, Aetna was a non-competitive bit player in the private insurance market having less than a 5% market share.

Submitted by bearishgurl on June 25, 2013 - 2:51pm.

SD Realtor wrote:
. . . It is very simple, at some point the sheer numbers do not get supported given cost parameters, and the number of those contributing. The result is a ever lower bar that is the common denominator.

This is my greatest fear. Having lost four immediate family members from illness, I fear losing access and choice. For example, I feel that if I wish to be treated for cancer at a program offered by the Mayo Clinic, MD Anderson or Johns Hopkins and am willing to travel, I should have that option. I didn't take care of myself all these years and pay my own premiums to wait 1-hour plus in waiting rooms with tons of patients (some of them sick) with their strollers in tow because they didn't get baby sitters, only to be seen for five minutes max by an overburdened provider who hasn't taken a lunch break.

I don't want to belong to a plan which gives little choice of providers to a multitude of *new* sign-ups in a given locale.

And I don't want to wait 10 months + for a date to get elective surgery.

Also, I feel most of the best doctors in SD are 60-plus years old. Many of these doctors (a few of whom are my current providers) are undoubtedly going to become incredibly frustrated with all the red tape dealing with the exchange and their *new,* possibly sicker patients going on the plans when they need care and then letting their plans lapse . . . repeatedly. And I fear they will also become disgusted with the low reimbursement rates due to very high administration costs in the state exchange bureaucracy. This will prompt them to throw in the towel and "retire" (because they can!) leaving the newbies and well-oiled medical-office machines (who give 2-3 mins to each patient after a 40+ min wait) to pick up the slack.

I just have a vivid recall of how the old SD Naval Hospital used to run (in Balboa Park) with shower curtains hanging a foot-plus from the floor separating patient rooms and the "pharmacy" set up exactly like a bus stop with a little window outside with a number machine and benches to sit and wait in front. I've come a lo-o-o-o-ong way since then and don't want to relive it :=0

Submitted by bearishgurl on June 25, 2013 - 3:10pm.

no_such_reality wrote:
. . . Frankly, Aetna was a non-competitive bit player in the private insurance market having less than a 5% market share.

NSR, Aetna IS a giant. It just lost most of its in individual market share in CA since 2011 because it has always been more picky on who it underwrites. It is NOT more expensive for those who take care of themselves but it is more expensive for the masses, thus, so many CA individual policyholders left Aetna in recent years and signed up elsewhere after getting repeated rate hikes ... as I did. Aetna is nationwide ... and believe it or not, a LOT of states have a "perceived" overall healthier population than CA ... at least perceived through the eyes of insurance companies. Almost ALL of Aetna's CA rate hikes since 2010 (and probably other health insurance companies as well) have been due to the fact that they couldn't deny coverage at will ... like they had been doing for years.

Believe it or not, it is NOT WORTH it for insurance companies to even collect a $1100, $1500 or $2100 a month premium on a LOT of "guaranteed-issue" new sign-ups.

I'm not stumping for insurance carriers here ... just stating facts.

Now, they will actually have to cover members of this population for as little as ~$550 per month (most of whom will have tax credits to pay most of the premium)!

I haven't checked which companies in the exchange will be administering the Medi-Cal plans but it is my understanding that the Medi-Cal masses will be waiting for the same care in the same waiting rooms as the self-insureds and employer-insureds.

Currently, the Medi-Cal masses, for the most part, use their own community clinics for office visits.

Submitted by The-Shoveler on June 25, 2013 - 3:48pm.

My two cents, I think Obamacare will be a complete disaster,
They should have held out for the full monty, a UK type of health plan,
this will be much worse than doing nothing.

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