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BAYOUBUZZ: If I wanted to get insurance I can go to an agent and i can say to the agent
please help me out with my insurance needs or I can go online to healthcare.gov and I
could try to get the information from the navigators from the site. Am I correct so
far? NOLAN: Right. absolutely. It's important to
know that the premium is the same whether you use an agent or you use a navigator or
you do-it-yourself, it's always the same, you do not pay anything extra.
BAYOUBUZZ: Now are the policies the same? NOLAN: Absolutely.
The policies are the same. Everything is the same
BAYOUBUZZ: So the reason I ask this is because, I went online and I saw an insurance policy
that I thought would be helpful, I talked to a navigator, I talked to an insurance broker
and I was very confused because the information I got online indicated that the coinsurance
did not have a cap so the co-pay and you are talking about the co-pay and the coinsurance.
NOLAN: Right BAYOUBUZZ: Now according to the insurance
policy the coinsurance did not have a cap but when I talked to the navigator they said
no this is capped by law so for example, the 20%, the 30%, that would be coinsurance
NOLAN: Right BAYOUBUZZ: I found that at least according
to the navigator that I would not have to worry about the 20%-30% over and above the
out-of-pocket costs and that's separate from the deductibles so
NOLAN: depending upon the information that you got there so many different plans that
you can pick from and there are parts of the law that cap the out-of-pocket, but different
ones operate different ways, some of them might have a deductible, you have to satisfy
your deductible and then everything is paid at 100%.
NOLAN: Or some might have co-pay. I know that Louisiana co-op, the're different, their co-pay
goes towards your deductible so there's a lot of little nuances. Some of the Blue Cross
plans actually have a $500 deductible for prescriptions in addition that people don't
realize, so there's a lot of different things with each one.
NOLAN: and then again if you are between 100 and 250% of poverty than those plans you pick
a silver plan with the deductible is reduced, your coinsurance is reduced, your copayments
are reduced. so it gets a little bit complicated. BAYOUBUZZ: Yes indeed. Sure it does but I
understand what you're saying with the differences in terms of the deductible and the co-pay
and the coinsurance, and deductibles going in for the out-of-pocket caps but as I appreciated
it, the main difference with this law is that the law says that the insurance company cannot
make the insured pay for anything over the out-of-pocket caps but the policies themselves
would indicate for example like let's say you go to the hospital and have $100,000 bill
what you have a cap for 6000, so as I appreciated it, anything over %6000 the insured is not
to be responsible, if the cap is 8000, then that's all you are responsible for--despite
the language of the policy that says 20/80 or 30/70 for the coinsurance..you
the way it works is you have a deductible--you satisfied that, and then depending upon the
plan whether it's 80/20, 70/30 the insurance company pays the 80/70 you pay the other (20/30).
Once that total equals up to your out of pocket, as you explained at 6000 or 8000, then your
plan is paid at 100% and what the law did was eliminate the annual or lifetime max so
it will never max out. But every year, your have the deductible and the out-of-pocket
starts over. BAYOUBUZZ: so assuming that is correct and
that is my understanding too, okay, and not looking at whether or not this is going to
bankrupt the country or anything of that nature, but just looking at the policy, the policies
as they are, and not considering privacy issues or anything like that, just the policies themselves--that
sounds like a pretty good deal for the insureds. NOLAN: Well, I'll tell you the good, the bad,
and the ugly. If you under 100% of poverty level there is no help. So if your talking
to somebody that says I make less than 11,500 and your single person you tell them that
they have to go to a free clinic--and it's heartbreaking-- if you make between hundred
and 400% of poverty absolutely the federal government helps you pay for the insurance
premium and sometimes the deductible and co-payment; those over 400% of poverty, the rate have,
are either doubled or tripled. So this helps some people make some people, its going to
make some people pay more, it just depends upon where you got, you fall into the category.
So those who gets subsidies, absolutely it it helps them, but it doesn't everybody and
I guess that's the law. BAYOUBUZZ: Yea, now, you mentioned about if
you're under the 100% and below, if you're in Louisiana then you have to go to these
clinics or the hospital or the, whereever the emergency room might be
NOLAN: right BAYOUBUZZ: Because the governor has not extended
the Medicaid, but in other states, in other states, the government has extended the Medicaid--am
I correct? NOLAN: Well he decided not to ask expand Medicaid
and I'll be honest it was very confusing during the session last year people did not understand,
I honestly don't understand, even if we expand Medicaid, if it is going to help people under
100%. My understanding is that it would help those 100 to 138% so if you're an employer
plan and and were in between 100 to 130% federal poverty, you can get off your employer plan
and you can get Medicaid. I am not sure and I actually have a meeting this afternoon with
DHH to find out if it really helps those under 100 and a lot of people think that Medicaid
is for the poor it is not--it is for if you're pregnant, if you're a child if you disabled
or if you're blind, it is not for the poor and is not for the working poor, and the law,
the ACA is not for the working poor-- so we really need to figure out where the Medicaid
expansion really help those under the hundred percent and if it doesn't then Louisiana needs
to create their own legislation that helps that group of people that have to go to free
clinics or one of the hospitals have been closed so they don't have a lot of options
to get help BAYOUBUZZ: Yea, it is my understanding that,
in the research I have done, is that basically if you are 100% percent and below that you
don't have any choice at all, but if there is Medicaid expansion, it would help those
people would be say in that bracket but if you have any information that DHH provides
I definitely like to be updated..but that's information that was provided to me, at least
by advocates of the Medicaid expansion and so I am just going to go by that of this point
,until I hear otherwise. NOLAN: it seems like to hear different things
from different sides and you just want to hear the truth, the truth, just what does
it really mean and I guess yet to meet somewhere in the middle.
BAYOUBUZZ: And that is what I been trying to do, and quite frankly I been trying to
get an idea as to who this helps and who it doesn't help and why. I mean. To me, it doesn't
make any sense that the state doesn't expand the Medicaid for these people unless they
have a system in place that will substitute for it.
NOLAN: Right BAYOUBUZZ: But if they don't have a system
in place that would substitute, then to me it would be very injurious to the peoplewho
need it the most and that's why I like to find out the system that they have in place
NOLAN:: And that's one of things I been trying to find out, because of legislators are confused.
I read an article about one of the Senators the other day who thought people between,
well actually thought that people, under 138% of poverty didn't get help in the in Louisiana,
and that's not true. And so I think this so many misnomers out there, so we need to get
to the facts and figure out what is going to help the people in Louisiana
BAYOUBUZZ: Definitely agree. BAYOUBUZZ: Now as for as you saying doubling
and tripling, I've done some research, I put together some hypothetical situations, my
numbers might be a little off or so but for example, a person making hundred thousand
dollars, 50-years old, single, a single male--a hundred thousand dollars, living in Jefferson
parish, the most he would pay or she would pay would be and i am just ball parking. Roughly
about 10 or $11,000, period. Okay. A year. And that is including the deductible and the
outer pockets and so that is what I'm trying to figure out, well, if that's what they're
saying on the website, then how in the world can the policy be doubling and tripling and
the out-of-pocket costs be any more than what the out-of-pocket cap Is.
NOLAN: Right, it is a little more confusing. NOLAN: Yea, it's a little bit more confusing
than that is definitely based on ZIP Code, that is important, no more male or female,
that the rating ratio used to be like 1 to 11 now it's 1 to 3. So if a young person is
charged hundred the most than older person be charged is 300. So those younger people
are going to have huge rate increases, older people or sick people who might be getting
rate increases because of their illness there's might actually come down. It would make them
come more to the middle. But you really can't say one person is going to the effect one
way. It's just that group of people based upon their age. So the 50 and over might actually
turn out pretty good for once BAYOUBUZZ: Or somebody with a pre-existing
condition NOLAN: exactly
BAYOUBUZZ: Who couldn't get insurance for that pre-existing condition or maybe couldn't
get insurance at all or had insurance and got kicked off or found out that wasn't covered
because the insurance company, you know, as we know has a way of trying to stop their
own hemorrhage. NOLAN: Right. That is one of the reasons why
recissions were included in the bill, that insurance companies couldn't find out that
you did didn't tell, you know, about a toenail fungus and cancel because you have leukemia.
Louisiana already had law so we didn't do that here but across the nation they did do
things like that and that was a protection for people who had something really wrong
with them. They had a cancer and the insurance company couldn't go and rescind that policy--unless
it was because of fraud. BAYOUBUZZ: Okay, uh. That I must tell you,
so like prior to the law, if I want to get insurance and I had a condition and I disclosed
that condition--as I understood it, the agent would say, "I'm sorry but you have to wait
a year or two years whatever it may be', and i think it's two years before they'll cover
that condition--Assuming you don't have any occurrences, paid occurrences, for that condition.
NOLAN: Companies work different, and each state, of course, their state regulations
is different, but some insurance companies wouldn't take them at all. And some might
have a rider that says we'll cover after two years..but some states there were passing
that somebody didn't disclose it and if it was something minor, or that they didn't think
about it, and the insurance company found it and would use that as a way to cancel the
coverage. But like I said, Louisiana already had laws, but this aspect of the ACA stopped
it from any state doing it. BAYOUBUZZ: Ok. Now so, the ACA stands, some
people are benefiting and some people are not going to be benefiting the deductibles,
in terms of what their deductibles or the premiums.
NOLAN: Right BAYOUBUZZ: Some of the premiums are going
to be higher than in the past and for other people premiums will be either the same or
lower NOLAN: Right
BAYOUBUZZ: The out-of-pocket caps, however is a tremendous benefit, for the insureds..not
so great for the insurance company and maybe not so great for the taxpayers of the United
States. Is that a fair statement? NOLAN: Well, I definitely think that having
caps is helping the person purchasing insurance, because, that means that they have to pay
less out of their pockets. So definitely helps them. But you're right, the trickle down as
to who it actually affects, taxpayers you know, that be coming into play but if you
just talking about an individual... absolutely...If I'm buying insurance having a cap on my out-of-pocket
definitely helps especially if I get some severe illness and be put to hospital whatever.
Whatever the worst case scenario is. BAYOUBUZZ: Yea, like a couple years goes,
for example, had a kidney stone and a bill all total was something like 80 or $90,000
and I'm going, my God, a kidney stone cause 80 to $90,000--so if that were to happen to
me or somebody else, now that would be a cap, there would be a cap I would not have to pay
to that 20 or 30%. I would just pay the 20 or 30% up to that cap.
NOLAN: Right, and really out of pockets have been in play--forever. I mean, they have always
been apart. But, this just makes sure that they're not any that are extravagant and really
high. So all the plans sold have to meet the rules of the ACA.
BAYOUBUZZ: Yea, that's very interesting and certainly appreciate it