Retiree Medical

[frayne]

Retired last year and DW and I will be 52 and 55 respectively this year. Both of us are in decent health and go to the doctors maybe twice a year, primarily for allergy shots and misc. I have retiree medical coverage through Atena at $300 a month, 80/20 plan with $20 co-pays, etc. and a $250/$750 deductable. Open enrollment started yesterday in the event I want to change coverage. In looking over the information a much cheaper, higher deductable plan is available for about $50 a month. Deductable is $2500/$5000 and after that is paid, the 80/20 kicks in. Simple math I could save approx. $3K a year by opting for the basic and cheaper plan. Also thought about setting up an HSA if I would qualify.

Debating on which route to take and wondering if I am missing something here. Any comments, suggestions or discussion is much appreciated.

 

[MasterBlaster]

In general high dedectable plans can save you money as you pointed out.

 

[SC]

I've also been wondering if the high deductable plans with an HSA would be a good idea.

My wife & I have been fortunate to have great insurance through our employers, and one thing I've noticed is that the insurance companies have negotiated a huge discount for themselves. Does anybody know, if you have a high deductible plan, do you pay the discounted prices or the full prices until your deductible is reached?

After my last checkup, the insurance statements showed that the visits and lab work would have cost me several hundred dollars with no insurance, but the insurance company paid a small fraction of that (maybe $150) and everyone was happy... I wouldn't mind a high deductible if I could get those same prices.

 

[REWahoo]

Does anybody know, if you have a high deductible plan, do you pay the discounted prices or the full prices until your deductible is reached?

After my last checkup, the insurance statements showed that the visits and lab work would have cost me several hundred dollars with no insurance, but the insurance company paid a small fraction of that (maybe $150) and everyone was happy... I wouldn't mind a high deductible if I could get those same prices.

With the Golden Rule/United Health Care HSA policy I looked at last year, you paid the discounted prices. I think this is likely to be the case in virtually all HSA policies. When you think about it, it is in both your and the insurance co's best interest for you to pay the discounted price. The less you pay for services, the longer it takes to eat up your deductible before the insurance company has to begin paying.

 

[Momtwo]

After my last checkup, the insurance statements showed that the visits and lab work would have cost me several hundred dollars with no insurance, but the insurance company paid a small fraction of that (maybe $150) and everyone was happy...  I wouldn't mind a high deductible if I could get those same prices.

Wouldn't that be great?  But that is not how it works. For Ex: I had Synvisc injections in both knees. At first the insurance company said they would not pay for it.  he bill from the Pharmaceutical Company to me was $1436. and they wanted it paid in full. I had the insurance company review their decision and they paid the Pharmaceutical Company in full.  Their paid in full price was $ 715.  If they had denied me again, I would not have gotten that price. My full price would still have been $ 1436.

 

[MasterBlaster]

Those inflated prices are there so that those not in the know pay for all of the people without medical insurance.

There is the going rate and the sucker rate.

 

[REWahoo]

Wouldn't that be great? But that is not how it works. For Ex: I had Synvisc injections in both knees. At first the insurance company said they would not pay for it. he bill from the Pharmaceutical Company to me was $1436. and they wanted it paid in full. I had the insurance company review their decision and they paid the Pharmaceutical Company in full. Their paid in full price was $ 715. If they had denied me again, I would not have gotten that price. My full price would still have been $ 1436.

Doesn't sound like you have an HSA or regardless of the price, you would have ended up paying rather than the insurance company. This sounds more like traditional insurance and a conflict with your insurer on whether or not the Synvisc injections were covered under your policy. Is this the case?

 

[dlhanson]

DW and I have chosen the high deductible plan since it has been available (3 or 4 years). I haven't been to a doctor for 20 years and DW hasn't for the last 10 years (we think that doctor visits are detrimental to one's health) so we have saved thousands of dollars so far.

DW is the only one really covered by our BP (the oil company) retirement medical plan (like yours administered by Aetna) since one of our DS is 25, the other is not a full time student, and I have no premium medical insurance with my current employer.

 

[frayne]

BP retiree (32 years) here as well. Thanks for your reply.

 

[dlhanson]

BP retiree (32 years) here as well.  Thanks for your reply.

I worked for Amoco--> BP for 23 years until my IT job was outsourced to SAIC. I finished in Naperville but I worked for BP/Amoco in 10 other places including one in Africa and another in Argentina. Now we live in SC where I teach computer science classes.

I thought based upon your enrollment dates and costs that you were also a BP retiree. While I lost my job after the BP takeover of Amoco, financially I gained much through a nice severence package, better retirement medical than Amoco had, and huge performance bonuses for the last few years. And I have a great new job!

 

[JohnP]

frayne - I'm glad you brought this up;  I've been thinking about HSA's and wondered how these 'systems' would address the retail-vs-discount price schedule described well by sc.  

DW and I have BCBS; we have experienced their attempts to not pay bills submited to them.  Further, I've gotten lots of their notifications about payments where there was substantial difference between the retail price and the discount figure.  My worry is that some smaller outfits wouldn't have the clout to demand and get the discount in a situation where the number of insurers increased dramatically, as envisioned in the HSA and high deductible health plan era discussed in the press.  

I cringe to think what will happen to health care costs when we will get our HSA from our favorite broker or bank and our high deductible health plan from the same people who planned the Medicare Plan D system.  I have a hard time seeing anything other than high fees and increased deductibles with the plans I've seen so far.  

JohnP

 

[TromboneAl]

I assume you guys have seen this thread on HSA's.

I first switched to a high-deductible when I ran the numbers in a spreadsheet and found that in most cases you came out way ahead with the high deductible. In the worst case, the high-deductible cost about $60 more for a year. IOW, the savings in premiums trumped everything.

I switched to an HSA plan last September.

 

[haha]

In looking over the information a much cheaper, higher deductable plan is available for about $50 a month.  Deductable is $2500/$5000 and after that is paid, the 80/20 kicks in.   

This price is amost a giveaway. It is much less than the high ded ins I was paying for most of my life.

Ha

 

[Mr._johngalt]

DW is between jobs, so I checked out a "short term"
health policy to fill in. Agent says "Coverage is effective at once" IF you can answer just 5 questions in the negative
(one page app.). I did this once years ago. Anyway, she
FAXed me the app. I think maybe I got one or 2 out of 5.
So much for that idea.

JG

 

[Martha]

DW is between jobs, so I checked out a "short term"
health policy to fill in. Agent says "Coverage is effective at once" IF you can answer just 5 questions in the negative
(one page app.). I did this once years ago. Anyway, she
FAXed me the app. I think maybe I got one or 2 out of 5.
So much for that idea.

JG

So why not COBRA? Too pricey?

 

[Martha]

One reason to have health insurance, even if you have a hugely high deductible, is to get the benefits of the lower negotiated rates between the provider and the insurer.

Bills for services should be submitted by the provider to the insurance company. This will determine the actual amount that is owned. This amount is almost always lower than the proposed fee for the service. Only when that is determined should you pay the provider.

I have helped a few people at work who have a provider who always seems to want the money now, before the bill runs through the insurance company. I have been successful in getting them to back off simply because you can't tell how much you really owe until the bill is processed by the insurance company.

 

[Mr._johngalt]

One reason to have health insurance, even if you have a hugely high deductible, is to get the benefits of the lower negotiated rates between the provider and the insurer. 

Bills for services should be submitted by the provider  to the insurance company.  This will determine the actual amount that is owned.  This amount is almost always lower than the proposed fee for the service.  Only when that is determined should you pay the provider. 

I have helped a few people at work who have a provider who always seems to want the money now, before the bill  runs through the insurance company.  I have been successful in getting them to back off simply because you can't tell how much you really owe until the bill is processed by  the insurance company.

This is good advice. If I have coverage (or even think I have coverage), I don't
pay until the insurance company responds, even if the provider wants their money
up-front (who doesn't?).

JG

 

[Mr._johngalt]

So why not COBRA?  Too pricey?

We opted out of the former employer's plan (no bang for our portion of
the "buck"). Thus, even while DW was employed we only had very minimal
(and cheap) coverage, bought on our own. We still have it, but I am queasy about the risks, so
even if DW went back to her old job we will be switching (again). That is,
if we can find something. It's going to take some work.

JG

 

[haha]

We opted out of the former employer's plan (no bang for our portion of
the "buck").  Thus, even while DW was employed we only had very minimal
(and cheap) coverage, bought on our own. 

Hard to imagine group coverage that wouldn't be significantly better than what you have described having. Insurance is an easy expense to get rid of, since you give up no noticeable pleasures from your life. But it can sure bite with a vengeance if you roll craps.

Maybe for DW’s sake, you should discuss your plans here, before turning your brain and willpower loose on the task?

Ha