Help! My health Ins is about to double!

[MBAustin]

Employer-subsidized insurance is no longer what it used to be, at least from my former megacorp. Just got my enrollment paperwork for 2016 and the premium is up nearly $100/month to over $400/month and the deductible and OOP max also went up slightly. But compared to what's available out on the market, it's still decent. My big concern is out-of-network as I still travel a good bit and also like the option to go to a specialist not in network. None of the marketplace plans offer out-of-network coverage, and a quick look at ehealthinsurance.com found only one that offers anything more than emergency care.

Dealing with the underlying cost issues in US medical care is way overdue, IMHO.

 

[bingybear]

Employer-subsidized insurance is no longer what it used to be, at least from my former megacorp. Just got my enrollment paperwork for 2016 and the premium is up nearly $100/month to over $400/month and the deductible and OOP max also went up slightly. But compared to what's available out on the market, it's still decent. My big concern is out-of-network as I still travel a good bit and also like the option to go to a specialist not in network. None of the marketplace plans offer out-of-network coverage, and a quick look at ehealthinsurance.com found only one that offers anything more than emergency care.

Dealing with the underlying cost issues in US medical care is way overdue, IMHO.

The market place ones... really all plans should offer out of network for emergency care, but they may play games with this. Make sure it is life threatening emergency care. I believe this was an ACA mandate. But some play some games about if it was necessary... or use an observation loophole.

 

[athena53]

Well, that's a little mushy. Let's say I'm traveling and have a closed fracture (no bone sticking out). Life-threatening? Probably not. Resetting it after I've gotten to an in- network facility after it's started to grow back together crooked would be expensive and risky. So what would the insurer say if I got immediate treatment out of network?

 

[Texas Proud]

I recall the "old days" fondly. In 1992 I was diagnosed with hypertension, hospitalized, finally put on meds; my employer provided insurance covered that. My doc had impressed on me how serious this could be by telling me to call his home number if I felt bad. A couple of days later I started feeling bad, numb left arm, pain in chest... A trip to the ER was in order, no heart attack, then. The heart attack came when I received the bill. I'd had a panic attack, my policy had no mental health coverage! Took years to pay that adventure off. No thanks, what we had before didn't work.

The problem is that still could happen... IOW, say you went to an out of network facility and they deemed it not an emergency.... they might not pay it.... now, I could be 100% wrong on this.... but you do hear horror stories....

 

[Texas Proud]

True. What you had before with your employer was healthcare, while your Bronze Plan now is health insurance. The difference was your employer subsidized the healthcare part, while you are now on your own. But that has changed with many employers. We have siblings still working, and they complain about their premium going up to several hundreds/month, and their deductible also goes up to a couple of thousands. One can blame that on the cost of healthcare, not on ACA.

By the way, the difference between healthcare and health insurance is the same as the difference between home maintenance and fire insurance. If we want State Farm to also cover our home maintenance cost in addition to the fire hazard, the premium is going to be higher.

Employer plans can be priced high also... my last companies plan was priced higher than what I can get on the exchange...

I looked at the district where my DW does some sub teaching and the premiums are 1.5X or higher.... now, it was a better plan, but I still think it was higher than a similar exchange plan...


The problem is that health care costs have continued to go up at a much higher rate and someone has to pay for it...

 

[Mr._Graybeard]

Perhaps we need tort reform that eliminates frivolous and time consuming lawsuits while still holding medical professionals accountable for truly negligent and/or malicious behavior.

In Wisconsin we have had tort reform. Here is the result: No Relief | Watchdog Report - Medical malpractice lawsuits plummet in Wisconsin

 

[ziggy29]

The market place ones... really all plans should offer out of network for emergency care, but they may play games with this. Make sure it is life threatening emergency care. I believe this was an ACA mandate. But some play some games about if it was necessary... or use an observation loophole.

Yes, ACA requires that *legitimate* emergency care (using the "reasonable lay person" standard in most cases) is covered at the same reimbursement rate for out-of-network providers. But the 800-pound elephant in the room is the remaining balance billing which can still happen in most states -- if an insurer will pay (say) $25K for a particular emergency in-network, they also have to pay $25K to an out of network provider. The difference is that the in-network providers would consider that $25K (plus your in-network share) to be payment in full, whereas out of network, you can still be billed many thousands more.

 

[ziggy29]

Employer-subsidized insurance is no longer what it used to be, at least from my former megacorp. Just got my enrollment paperwork for 2016 and the premium is up nearly $100/month to over $400/month and the deductible and OOP max also went up slightly. But compared to what's available out on the market, it's still decent. My big concern is out-of-network as I still travel a good bit and also like the option to go to a specialist not in network. None of the marketplace plans offer out-of-network coverage, and a quick look at ehealthinsurance.com found only one that offers anything more than emergency care.

Yeah, this is my first FEHB open enrollment and I'm noticing that the premiums are (on average) about 8% higher than last year -- sometimes 20% more, sometimes actually *down* slightly -- but also with higher deductibles and OOP limits in most plans. To me, the main difference is that most of the FEHB plans still have relatively strong PPO networks.

In reality, if I were still fully retired, looking at the HMO-only offerings on the Marketplace might get me interested in dusting off my resume. Yeah, there's that Humana PPO plan that is offered in my county, but over $500 a month just for me is a little steep, especially with no subsidy or tax deduction for the premiums...

 

[Tandemlovers]

The market place ones... really all plans should offer out of network for emergency care, but they may play games with this. Make sure it is life threatening emergency care. I believe this was an ACA mandate. But some play some games about if it was necessary... or use an observation loophole.

I can speak to this. In our case, our emergency required care in another state, and the out of network hospital provided care in the ER and in the ICU for six days. I called our insurance company within hours of admission to inform them of the situation, and they assured me that we had coverage.

It sounds silly now to admit this, but I thought that we were required to write a check to our insurance company for the amount of the deductible. It took several explanations for it to sink in that as far as our insurance company was concerned, our deductible had been met. We were responsible for any bills from the out of network provider. So, we waited through several billing cycles to receive our final bill, and just this morning, I called their billing office to see if I could negotiate a cash payment. We settled on an amount that is less than our deductible. Not having ever had to deal with hospital bills before, I was pleasantly surprised at the ease with which this was handled.

I don't know if this is relevant, but our insurer, and the out of network hospital both used Epic software, so we were easily able to transfer records from the out of network hospital to our local health care provider. Amazing.

 

[Mulligan]

In Wisconsin we have had tort reform. Here is the result: No Relief | Watchdog Report - Medical malpractice lawsuits plummet in Wisconsin

The two parts of medical cost I hear about is doctors salaries and malpractice. But they combined are way less than 15% of total healthcare cost. Malpractice was about 3% I believe.... Now defensive medical care used to prevent successful lawsuits I am sure is not part of that though. It is just hard to wrap your arms around the whole wasteful process... I havent...


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[ziggy29]

The two parts of medical cost I hear about is doctors salaries and malpractice. But they combined are way less than 15% of total healthcare cost. Malpractice was about 3% I believe.... Now defensive medical care used to prevent successful lawsuits I am sure is not part of that though. It is just hard to wrap your arms around the whole wasteful process... I havent...

Yeah, I've heard that "defensive medicine" is actually the main component of the cost of a litigious society on the health care system. Of course, one person's "prudent precautions" are another person's "unnecessary defensive medicine".

That said, the cost containment problems go much deeper than any one thing. One group of people seems to focus on insurance company and drug company profits, the other on a lawsuit-happy system, but even if you took all those out of the total that the USA spends on health care, it would *still* be a lot more per capita than just about anyone else on the planet pays, and by a fairly wide margin. Our cost problems are systemic and go far beyond any particular action group's pet bogeymen.

 

[bingybear]

The problem is that still could happen... IOW, say you went to an out of network facility and they deemed it not an emergency.... they might not pay it.... now, I could be 100% wrong on this.... but you do hear horror stories....

I can speak to this. In our case, our emergency required care in another state, and the out of network hospital provided care in the ER and in the ICU for six days. I called our insurance company within hours of admission to inform them of the situation, and they assured me that we had coverage.

It sounds silly now to admit this, but I thought that we were required to write a check to our insurance company for the amount of the deductible. It took several explanations for it to sink in that as far as our insurance company was concerned, our deductible had been met. We were responsible for any bills from the out of network provider. So, we waited through several billing cycles to receive our final bill, and just this morning, I called their billing office to see if I could negotiate a cash payment. We settled on an amount that is less than our deductible. Not having ever had to deal with hospital bills before, I was pleasantly surprised at the ease with which this was handled.

I don't know if this is relevant, but our insurer, and the out of network hospital both used Epic software, so we were easily able to transfer records from the out of network hospital to our local health care provider. Amazing.

Likely not relevant, but thanks for plugging the company my son works for (software developer).
BTW, what kind of tandem do you ride? I have a Trek.
I worried quite a bit when I spent 5 days or so in the hospital and came out with a shiny pacemaker (not ACA). I blew my deductible (covered by HRA). The entire year was less than $250 out of our pockets. Doubt I'll ever have a plan like that again.
I'm amazed at what some hospital charges are... but I think they plan of concessions. you know... all the "agreed upon rates".
I'm glad it worked out well for you.

 

[Mulligan]

Yeah, I've heard that "defensive medicine" is actually the main component of the cost of a litigious society on the health care system. Of course, one person's "prudent precautions" are another person's "unnecessary defensive medicine".

That said, the cost containment problems go much deeper than any one thing. One group of people seems to focus on insurance company and drug company profits, the other on a lawsuit-happy system, but even if you took all those out of the total that the USA spends on health care, it would *still* be a lot more per capita than just about anyone else on the planet pays, and by a fairly wide margin. Our cost problems are systemic and go far beyond any particular action group's pet bogeymen.

I was on the treadmill today reading a Fortune Magazine article on healthcare costs today. I do not know if this is a "bogus stat" or not as I do not know the cumulative populations of the countries cited. But article said we spend more than 2x as much cost in medical care as France, England, Germany, Italy, and Spain combined.


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[Tandemlovers]

Likely not relevant, but thanks for plugging the company my son works for (software developer).


Interesting! Big employer of students coming out of UW, but boy, they can expect to work "epic" hours!

BTW, what kind of tandem do you ride? I have a Trek.


We bought a daVinci in 2009. Used to have a Cannondale that I *really didn't like* to ride. As the stoker, I appreciate not having to adhere to the captain's cadence : ) We are a much happier tandem team if the stoker can coast while the captain pedals to his heart's content : )

 

[ejman]

I don't know if there are any Western European readers of this forum but I personally would love to hear first hand accounts from folks that have actual real experience with the health system in those countries. Reason for my question is that there's got to be something better than the crazy system we got here in the USA and there is so much smoke being blown @ these shores that the only thing I would trust is first person accounts.

 

[mpeirce]

The OP doesn't have a pre-existing condition. And doesn't qualify for the subsidies.

So basically he gets to chip in to help pay for the people in those two categories.

I can see why people in those two categories like the ACA. I can also see why everyone else is pretty upset about it.

 

[ziggy29]

But article said we spend more than 2x as much cost in medical care as France, England, Germany, Italy, and Spain combined.

Per capita? That's really what matters. We probably spend 10,000 times what San Marino does....

 

[Mulligan]

I don't know if there are any Western European readers of this forum but I personally would love to hear first hand accounts from folks that have actual real experience with the health system in those countries. Reason for my question is that there's got to be something better than the crazy system we got here in the USA and there is so much smoke being blown @ these shores that the only thing I would trust is first person accounts.

One of my best friends wives was born and raised in England before moving across the pond several decades ago. Parents stayed resided in England. She is a devout advocate of national healthcare. Her father had several joint replacements and she said he was very pleased with the process there.She did say that he probably had to wait a few weeks more there than here to get it done since it wasn't a medical necessity.


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[bingybear]

Likely not relevant, but thanks for plugging the company my son works for (software developer).


Interesting! Big employer of students coming out of UW, but boy, they can expect to work "epic" hours!

BTW, what kind of tandem do you ride? I have a Trek.


We bought a daVinci in 2009. Used to have a Cannondale that I *really didn't like* to ride. As the stoker, I appreciate not having to adhere to the captain's cadence : ) We are a much happier tandem team if the stoker can coast while the captain pedals to his heart's content : )

The epic hours don't compare to my ATT/Lucent hours. For me 100 hour weeks were common. DaVinci is a nice bike. DW would like part of that.. Still hates the speed I'm willing to go.

 

[brett]

We live in Canada. There are challenges with our health care system but overall people are very happy. Every poll has shown an 80 percent plus approval rating. We hope to include prescription drugs, we call it Pharmacare' over the next five to six years. It has been a recommendation by our medical associations for a number of years. We are the only western country that does not include prescription drugs in our healthcare plan. The drug companies and insurance companies are against it so I figure it must be a good idea!

We have no concerns about being placed into personal bankruptcy by health care costs. Health care or monthly health care premiums did not come into play when I retired early at 58. We did not have to consider it. We pay our health care through taxes, and in some cases, low premiums. My daughter recently had significant issues with her pregnancy. More than once she was airlifted from her home hospital in a northern community to hospital in city. She spent weeks in the hospital with multiple specialist involved. We only had to concern ourselves her health and the health of the child. Absolutely zero direct, including the medevac, cost to her. Same with my father who had multiple heart surgeries, pacemaker, etc.

I believe that the difference is that we view healthcare as a basic right of all citizens. The notion that health care should be linked to one's employment or employer benefits is completely foreign to us and we do not understand the logic of it. For us, medicare is no different than police/fire protection or having clean water coming out of our taps. Some call our system socialized medicine yet those same people don't refer to our police/fire/water etc. systems as socialized in a contemptuous way. I do not understand this given the parallels.

As I recall, we are about at a 12percent GDP cost of healthcare with outcomes that are similar or better than the US depending on the line item. I believe that our per capita spend on healthcare is significantly less. This is the same as western Europe and Australia. But our number is not yet increasing at a unmanageable rate. Some people in Canada view our system as substandard to some of those in Europe. I cannot comment on this.

 

[bingybear]

I don't know if there are any Western European readers of this forum but I personally would love to hear first hand accounts from folks that have actual real experience with the health system in those countries. Reason for my question is that there's got to be something better than the crazy system we got here in the USA and there is so much smoke being blown @ these shores that the only thing I would trust is first person accounts.

I lived in England for 2 years. I got care when I needed it. Doctor was covered, medications were affordable. I knew people with cancer and heart problems that were treated in reasonable time frames... and covered. I don't live there now, but it seemed to work reasonably without breaking the individual's savings.

 

[traineeinvestor]

I don't know if there are any Western European readers of this forum but I personally would love to hear first hand accounts from folks that have actual real experience with the health system in those countries. Reason for my question is that there's got to be something better than the crazy system we got here in the USA and there is so much smoke being blown @ these shores that the only thing I would trust is first person accounts.

Not in Western Europe, but my brief experience with the US health care system was "interesting". I worked for a US firm which (unsurprisingly) engaged a US insurance company to provide medical insurance for its employees worldwide.

We always took the worldwide coverage option which excluded the US and Caribbean as the premiums were a lot lower and we had no plans to visit the US (except on business which was covered on a separate plan).
As a partner, I had to pay the premiums myself. When Obamacare took effect (i) the premiums went up by 97% and (ii) a whole bunch of new/increased co-pays, caps and deductibles were introduced and (iii) the policy was re-written with the descriptions of what was covered/excluded being much longer. Bear in mind this was for coverage of non-US persons outside the US.

Fortunately, we were eligible to join DW's employee plan offered by a European insurer. The premiums went back to slightly above the old level and the deductibles, caps and co-pays were either removed or set at much more pleasant levels. The exact savings would have depended on what claims we had to make, but the net-to-us cost of health care about halved by getting out of the US system. We also got a comparatively plain-English explanation of what was covered/not covered and a very helpful help-line which meant we spent less time and experienced less stress in dealing with claims.

If we had not been able to switch to the European insurer, we were considering ditching the US policy and just buying a local policy that covered major events and paying for the small stuff as we went and/or relying on the Hong Kong public health system (which I would rate as adequate rather than good or bad).

 

[Mulligan]

Per capita? That's really what matters. We probably spend 10,000 times what San Marino does....

Im assuming that was the assumption though it just said total healthcare cost. I did a quick tally and was surprised. Total population of the 5 countries was 316 million and US is about 310. I would never have thought Spain's population was nearly the same as France and UK.


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[zinger1457]

Has anyone who's cost have gone up dramatically considered switching to one of the christian healthcare ministries to save on cost? I realize it's technically not 'insurance' but it is ACA compliant. If my health care premiums were at the level some have quoted I'd probably give it a serious look.

 

[Texas Proud]

Just want to point out that it is not only defensive medicine that creates the high cost of health care...

As an example before, a joint replacement here cost $50K and somewhere in Europe cost $12K... there is not difference in the operation.... so all the extra fee goes to pay for something that is not needed....


I do not know who to blame... but I suspect it is a bit from everybody that creates the problem... we just see a small part and make assumptions.... and from what you read it seems almost everybody in the system is just about to go out of business because they cannot make money....