Chiropractor Orange CA | Dr  Barry Marks

Orange County CA Obamacare Update

Orange County CA Obamacare Update


Orange County Residents Facing Massively Rising Health Care Costs Under Obamacare

Orange County Obamacare update

Covered California is the California exchange for the Affordable Care Act (ACA) (aka Obamacare). Health care providers are now starting to see trends in health insurance policies as more patients are showing up with Obamacare coverage. The trends do not bode well for doctors and their middle to upper income patients and will worsen as employer plans move towards the government sponsored plans.

Here are observations from several providers of differing specialties in Orange County, California.

  • > Deductibles are averaging $6,000 per person, $12,000 per family. The policy will not pay for any medical care until the deductible amount has been paid by the patient.
  • > Co-payments are averaging $45.00 per visit. This is the amount the patient must pay at the time of service and the insurance plan will pay a specified amount after that.
  • > Many doctors and facilities are not covered because they do not belong to the specified networks.
  • > Chiropractic coverage is handled as “in-network” HMO coverage even though the overall medical plan says it is a “PPO” in some plans.
  • > Insurers are not mandated to provide Chiropractic coverage in CA, so many plans do not offer it. Acupuncture, however is mandated in every policy.
  • > Families who have “grandfathered” policies and have children after the ACA implementation date, must give up their policy and go with a CoveredCA plan to cover their child or keep their existing plan, but MUST put the new baby under MediCal (the California version of MedicAid the health insurance for low income residents) even if the parents are able and willing to pay for a different policy.
  • > Insurance premium quotes and deductible and coverage amounts differ from the online application, to the actual policy being sent to review and sign up and then the actual bill being received from the insurer. In each instance the premiums go up and the coverage percentage goes down.

These are observations from several private individual doctor’s offices around Orange County, California. Patients are very frustrated because they have no idea what their coverage is and the insurance companies cannot be relied on to answer questions and will give wildly different explanations with each phone call.

Who Likes the New Obamacare Plans?

Patients who had no insurance before and are of relatively low income are happy with the plans because they are cheap (heavily subsidized by other tax payers) and have fairly low deductibles and co-pays. Of course previously they could’ve just qualified for MediCal and paid next to nothing.

Who Dislikes Obamacare?

The unhappy patients are middle to high income self employed people who had to give up $500 – $1,000 deductibles in favor of $6,000 – $10,000 just to be able to afford the premiums (many are not subsidized). They are also paying in co-pays after their monumental deductible is met, practically what a pre-Obamacare cash visit would have cost.  Patients are also unhappy with the choice of doctors, particularly if they must put their children on MediCal, since the majority of OC physician’s do not accept MediCal. A family may now have 2 or 3 policies to cover their family, raising costs and receiving less quality care.

Obamacare, a Contradiction

Prior to implementing this “Law,” the American people were told that high deductible, high co-pay plans were ridiculous and gimmicky plans that nobody should be allowed to buy. We learn now that, the plans they referred to as gimmicky (Called Major Medical or Catastrophic plans with $3,000 deductible, 20% co-pay, 80% coverage for as little as $200/mo) would be considered a premium plan compared to what is offered now! Californians are paying higher premiums than ever, 200-500% higher deductibles than previous years and having to shop for a doctor that will take their coverage.

On the Horizon

The next wave of problems will hit later this year or early next year as many large employers will push their insureds off of their roles and onto the exchanges. When patients who have had fairly good policies paid mostly by their employers see what they get from Obamcare, you will hear a collective groan across this state for sure.

What Our Office is Doing About This Problem?

We will continue to offer you the best quality chiropractic pain relief treatment possible at a reasonable cost. It doesn’t matter these days what your insurance coverage is when it comes to chiropractic care. If you have an old plan that covers chiropractic, you will have a reasonable deductible and co-pay for now. If you have a new policy that covers or does not cover chiropractic it ends up costing you the same. Our pre-paid cash fee is only a few dollars more than the co-pay of most policies nowadays.

We will always treat you with respect and give you options to choose from when it comes to your unique treatment needs.

For more information about your specific needs or health care policy call our office at (714) 938-0575. We will be happy to help you find the solution that fits your needs and budget.




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