About hoofin

Was an American expat in Japan, with roots in Somerset County, New Jersey. Now back in Pennsylvania.

Obamacare’s Third Open Enrollment began Sunday (November 1). What has changed in Lancaster?

Well, quite a bit.

Obamacare’s Premium Tax Credits are based on the Second-Lowest-Cost Silver Plan (SCLSP).   For two years running, this had been a Highmark offering, the Health Savings Blue PPO 1700.   It is a preferred provider organization, so that you were given a lot of coverage if you stayed “in network”, and less if you went out of network.

For all the complaining that people in this goofy Tea-Party influenced Republican party area did, a lot of people signed up for the 1700, enough with medical issues that Highmark will stop offering the 1700 on January 1, 2016.

What has filled the space of the SCLSP is a Keystone HMO offering.   Keystone is a subsidiary of Capital Blue Cross.   In fact, most of the low-cost Silver Plans for 2016 are Keystone HMOs.  Capital Blue was a lot more objective about pricing its plans over the last two years, so these HMOs cost more than what the 1700 PPO had.   But it is going to be a shock to many people in the county, and in other parts of Pennsylvania, that their nice PPO is disappearing, and they are being offered the narrower networks of HMOs instead.

People can still sign up for PPOs on the Marketplace in Lancaster County, but the prices are higher than for the HMOs.   This makes sense, because the difference between the two types of insurance is that the PPO is giving you additional coverage if you opt out of the network, and it isn’t forcing you to get an OK of a primary care physician.

When I was in Japan, there was none of this nonsense.   There was either insurance through the local municipality, or through the employer.   Everyone got the same coverage, and everyone paid premiums based on a sliding scale of the prior year’s income.   When I had the near-104 fever Christmas week of 2008 (working for IBM Japan), the emergency room visit, IV and all, cost maybe $70.   That was 30% of the actual bill.   X rays of my (now diagnosed) varus feet cost maybe $20.

When I came back to America, everything I had ever been checked on in Japan became “pre-existing conditions”, and I would not have been able to be covered.  That all ended at the end of 2013.

I am disappointed that Pennsylvania’s Marketplace has been screwed around a little by Highmark, which did people a short-term favor with the cheaper PPOs, but caused what is known as sliding Silver to hit people with a rate shock for this third open enrollment.  The Capital Blue-sponsored HMOs are probably not bad, but the change will probably surprise many.

(If you have never enrolled in Obamacare, visit www.healthcare.gov.)