Help! My health Ins is about to double!

[bingybear]

I don't need an in network doctor to admit me

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you two seem to be talking different areas of insurance.
you seem to be focused on your "independent" PCP that you pay more for than all my OOP for medical and dental (w/o insurance .. and included 2 crowns) [<1k for DW and myself]
and I think Ziggy is on a different line of what would happen if you ended up in an ER (your PCP might not be there... you could be out of state... or whatever) and you may have some non-network doctors or facilities or balanced billing.

I would wonder how your insurance would cover tests ordered by your non-network doctor. Say you needed an MRI. Do you need to get an in network doctor to write a script for that?

I do appreciate you description of removing all the insurance reporting reducing costs for your doctor. Likely one of many areas to help cut costs.

 

[FreeBear]

One of our problems is that most of the health coverage was covered by employer plans where the insured had no idea of what it really costs.

+1 Agreed, but it's just not employer plans. Just after nice Megacorp plans, you can think of Medicare. Folks on ACA seem to count the days until Medicare. We know someone on Medicare who has paid only about $1K OOP of the $300K+ costs due to a very serous illness. Funny to think of Medicare as the new Gold Standard in HI as someone here suggested.

 

[ivinsfan]

+1 Agreed, but it's just not employer plans. Just after nice Megacorp plans, you can think of Medicare. Folks on ACA seem to count the days until Medicare. We know someone on Medicare who has paid only about $1K OOP of the $300K+ costs due to a very serous illness. Funny to think of Medicare as the new Gold Standard in HI as someone here suggested.

The folks on ACA might not realize that kind of coverage will cost around 350+ a month per person or 700 per couple, yes no co pay to speak of but I bet many ACA coverages are under that number.

 

[audreyh1]

The folks on ACA might not realize that kind of coverage will cost around 350+ a month per person or 700 per couple, yes no co pay to speak of but I bet many ACA coverages are under that number.

A lot of ACA coverages are at or higher than those numbers.

And non-subsidized ACA folks face much higher deductibles than Medicare folks.

Plus having to deal with all the out-of-network nightmares.

 

[youbet]

The folks on ACA might not realize that kind of coverage will cost around 350+ a month per person or 700 per couple, yes no co pay to speak of but I bet many ACA coverages are under that number.

Yes. Part B plus Part D plus deluxe supplement would be $600 to $700 per month for a couple on SS. Much more if your joint MAGI is $170k or more. You also pay a lifelong tax of 2.5% prior to coverage beginning at age 65.

Not a bad deal but not "free" as some folks think.

 

[FreeBear]

Very valid point. I recently lost weight thanks to cleaning up our diet, exercise too. When he asked me about some of the prescriptions I had been on he appeared dumbfounded that I no longer wanted them. No doc, it took me months of not sleeping to get off of Ambian, I'm not taking any more!

Since doing that I no longer have symptoms of or take medicine to control:
Tachycardia
Hypertension
Triglycerides
GERD
Insomnia

DW has had similar sucess. Not a bad trade off in my mind!

Congrats MRG on taking control of your health. DW and I (actually more DW) improved our diet and we've both lost tons of weight. We avoided/stopped some of the same issues you listed just by diet and modest exercise.

DW and I constantly remind each other that under ACA we can no longer afford unhealthy lifestyles. The deductibles and OOP would kill us, not to mention the "lifestyle" illnesses themselves.

It's interesting that most folks here strongly advocate taking care of most/all of their own finances. Experts like lawyers, accountants, and FA should be used sparingly on an as needed basis. Well, DW and I feel the same way about our health. We want to maintain it as well as possible by diet and exercise, and also know enough to see when to call in an expert from the healthcare, I mean sick-care, money complex.

FB

 

[FreeBear]

And non-subsidized ACA folks face much higher deductibles than Medicare folks.

Plus having to deal with all the out-of-network nightmares.

+ 1

Right there audreyh1, our two biggest concerns in sick-care, maybe even all of ER. Actually, out-of-network is even more scary than big deductible and OOP. At least these are known & constrained evils. The out of network issues can pop up unexpectedly, and some plans have no constraint on the damage level. This defeats one of the biggest reasons for insurance: moderating or at least constraining risk.

FB

 

[ziggy29]

It's interesting that most folks here strongly advocate taking care of most/all of their own finances. Experts like lawyers, accountants, and FA should be used sparingly on an as needed basis. Well, DW and I feel the same way about our health. We want to maintain it as well as possible by diet and exercise, and also know enough to see when to call in an expert from the healthcare, I mean sick-care, money complex.

There are some fair points here. But at the same time, not everyone is genetically blessed and even people who do everything right can get cancer, just as people who are generally financially responsible can hit hard times through circumstances not of their own making.

I'm not sure it's really a fair point, though, to suggest that people who are "responsible" financially are not responsible when it comes to their health.

 

[Katsmeow]

The folks on ACA might not realize that kind of coverage will cost around 350+ a month per person or 700 per couple, yes no co pay to speak of but I bet many ACA coverages are under that number.

DH has been on Medicare for about 3 years now. I am not yet on Medicare. There is no question that Medicare is far cheaper. He pays a little under $300 a month (his precription drug plan is made for by the Megacorp he retired from). In the past 3 years, his out of pocket costs have been negligible. He was Plan F for his medigap coverage. Basically his out of pocket costs have been for a couple of prescriptions. (He did have an eye exam and new glasses, but those aren't covered under private insurance either). Every doctor he has wanted to see accepts Medicare. Last year he had major shoulder surgery with several months of PT, all covered. This year he had to go to the ER a couple of times, which resulted in prostate surgery. All of it was covered with no cost sharing by him.


For the upcoming year, I will be (with 2 of our kids) on an off-exchange plan. The share of the premium just for me would be about $750 a month (I'm not paying that as most of the cost is subsidized by DH's former employer). However, the family deductible is $12,800 (individual is $6400) and the family out of pocket maximum is $13,400 ($6700 individually). There are co-pays with deductible waived for generic meds and for visits with doctors (that doesn't include lab tests or imaging though). And, there is no out of network coverage except for emergencies.

If DH were to develop cancer, he could go to MD Anderson. If I were to develop cancer, I could not. Medicare seems like a significantly better deal.

 

[youbet]

Medicare seems like a significantly better deal.

I haven't read any posts saying that Medicare (plus a supplement) was not a better deal than most non-Medicare policies. Although we do need to figure some way to include the 2.5% lifetime tax into the Medicare cost equation some way.......

What people, including me, are saying is that Medicare plus a supplement is going to cost upwards of $300/mo each or upwards of $600/mo for a couple. And you have to pay 2.5% of your income for life to qualify to pay that. Still, likely the best HI deal going for most geezers.

Couples just need to remember to pencil in $8k or so annually to pay for it. Somehow, the rumor that Medicare is free, or near-free, persists

 

[Katsmeow]

What people, including me, are saying is that Medicare plus a supplement is going to cost upwards of $300/mo each or upwards of $600/mo for a couple. And you have to pay 2.5% of your income for life to qualify to pay that. Still, likely the best HI deal going for most geezers.

Yes. It is just that compared to what I pay, the cost of Medicare is peanuts and without all the out of network angst that you always have with non-Medicare insurance.

Yes, I now that say $7200 a year is not literally peanuts. But, last year our family medical expenses for insurance and healthcare costs were well over $20k (that includes 2 of our kids). Even taking the kids out of the pictures, the costs will go down a lot when I become eligible and I won't have to worry about the whole out of network thing.

 

[audreyh1]

I don't hear people talking about Medicare as if it were free.

 

[meierlde]

On the 2.5% tax that pays for Part A (Hospital) unless you exceed about 250k in income the tax is not imposed on capital income, pension and Social Security.

 

[FreeBear]

Couples just need to remember to pencil in $8k or so annually to pay for it. Somehow, the rumor that Medicare is free, or near-free, persists

Good reminder. We burn about 20% more than this now for lowish Bronze crappy ACA (full PPO network disappearing for 2016). Still, the big anticipated advantage of Medicare is, presumably, better network coverage and lower OOP.

FB

 

[DEC-1982]

I think the 2018 Cadillac tax on employees healthcare benefits would produce a slightly better balance between employees and non-employees but I wouldn't be surprised if our politicos cave in under pressure and reduce/remove that 2018 tax. For budgetary reasons that means politicos would stick it to somebody else, new target(s) yet to be determined. Who has the least clout?

The good news (in one way) is that right now employers are exposing their employees to ever-increasing healthcare costs by increasing their premiums, deductibles and out-of-pocket costs. The more EVERYBODY sees the problem, the higher the chances of actually doing something to control costs at their source, as mentioned in NW-Bound's post.

 

[NW-Bound]

We relocate to the UK next year* and I have already done a detailed tax estimate for what we will pay for our circumstances.

We have a mixture of pensions, interest, qualified dividends and capital gains. Like the US, the UK taxes its residents on their worldwide income. Roth distributions are free of UK tax which is why I have been so aggressive in conversions this past 5 years.

We will pay ~$3k more in income taxes than in the US ($9k instead of $6k). (We live in Texas so no State income tax).
...

*We are moving back for emotional reasons (family and friends) , not financial or because 1 country is somehow better than the other.

Yet, you are retired and I assume that your current income is less than that when you were both working and the tax would have been much higher.

 

[bingybear]

Congrats MRG on taking control of your health. DW and I (actually more DW) improved our diet and we've both lost tons of weight. We avoided/stopped some of the same issues you listed just by diet and modest exercise.

DW and I constantly remind each other that under ACA we can no longer afford unhealthy lifestyles. The deductibles and OOP would kill us, not to mention the "lifestyle" illnesses themselves.

It's interesting that most folks here strongly advocate taking care of most/all of their own finances. Experts like lawyers, accountants, and FA should be used sparingly on an as needed basis. Well, DW and I feel the same way about our health. We want to maintain it as well as possible by diet and exercise, and also know enough to see when to call in an expert from the healthcare, I mean sick-care, money complex.

FB

I'm impressed that you know when to get medical help. I had a few light headed instances a few years back, less than 10 seconds at a time. After less than 5 I went to the ER or recommendation of my PCP. Note that when the light headed feeling was not happening, I was fine, could exert myself to very high levels for long periods of time.
I got admitted for testing. Cardiology did its testing and said I was good to go. Waiting on neurology tests, I had 3 more light headed instances. I asked the nurses after each one if the wireless EKG caught anything....nothing. After the 3rd time a nurse manually went through the data and found a class 3 heart block. The way they catch these is to capture the event which my not occur all that often.
While I was in the hospital I really questioned if I had over reacted. Normally I would have waited longer to search out help.
I don't always know when to search out help. I've gone to urgent care and got stitches when I should have treated it at home with ice and proper bandaging. I make some educated guesses, but I don't know since I'm not always right.

There are some fair points here. But at the same time, not everyone is genetically blessed and even people who do everything right can get cancer, just as people who are generally financially responsible can hit hard times through circumstances not of their own making.

I'm not sure it's really a fair point, though, to suggest that people who are "responsible" financially are not responsible when it comes to their health.

ziggy, I didn't take Freebear's comments were implying fault for everyone who gets ill. But even when one had tendencies to have certain health problems does not mean they should not try to live in healthy manners: diet , exercise, etc. You seem aware of the cancer issues, I would assume you are watching for symptoms and checking with healthcare professionals when necessary..."know enough to see when to call in an expert from the healthcare"

 

[audreyh1]

I sometimes hear people talking as if maintaining a healthy lifestyle will mean they don't get sick or need expensive medical attention. But there are many, many diseases, some expensive, and some chronic, that have nothing to do with lifestyle. Not to mention accidents causing major health expenses - sometimes with long term consequences. No matter how careful you are, you can still be involved in an accident.

 

[easysurfer]

I sometimes hear people talking as if maintaining a healthy lifestyle will mean they don't get sick or need expensive medical attention. But there are many, many diseases, some expensive, and some chronic, that have nothing to do with lifestyle. Not to mention accidents causing major health expenses - sometimes with long term consequences. No matter how careful you are, you can still be involved in an accident.

+1.

Maintaining a healthy lifestyle helps stack the odds in your favor, at least until you are ready to meet your maker (a heart only has so many beats), but the healthy lifestyle is not guarantee.

Earlier in the year I was doing fine that I helped a brother move, but a few days after I was hobbling around for a day or two with a cane. Back to about 99% okay now, but a reminder one can be feeling great one moment then terrible in a flash.

 

[NW-Bound]

In contrast with auto insurance where a driver can really help with his driving habits, healthcare for each of us will go up as we age. And I have read that lung cancer patients cost less for healthcare than people we would consider healthier, for the morbid reason that they die off sooner.

I think the cost for healthcare is difficult to contain if we keep the idea that a human life must be prolonged at any cost. It is hard to put a price on a day of life for a terminal patient, but the truth is that we already do in other situations.

How much do surviving families of victims of wrongful death get in lawsuits? If you take the amount awarded and divided by the victim's days that he would have lived, it comes out a lot less than what we spend to keep dying patients alive.

 

[REWahoo]

I sometimes hear people talking as if maintaining a healthy lifestyle will mean they don't get sick or need expensive medical attention.

Healthy lifestyle? We don't need no stinkin' healthy lifestyle.

As my dad was fond of saying in his latter 80's, "If I had known I was going to live for so long I would have taken better care of myself."

 

[NW-Bound]

Healthy lifestyle? We don't need no stinkin' healthy lifestyle.

Same with life as anything else, we have to ask ourselves, do we want quality or quantity?

 

[bingybear]

Same with life as anything else, we have to ask ourselves, do we want quality or quantity?

Not sure these are competing qualities. I like hiking, biking, sailing.... active life style. But this should be good for longevity. So I vote for both! It is not necessarily a continuum of states where you trade quality for quantity.

 

[audreyh1]

In contrast with auto insurance where a driver can really help with his driving habits.....

No matter how good a driver is, other people can still cause bad accidents.

And you don't have to be driving, or even in a car, to be involved in an accident either!

 

[audreyh1]

Not sure these are competing qualities. I like hiking, biking, sailing.... active life style. But this should be good for longevity. So I vote for both! It is not necessarily a continuum of states where you trade quality for quantity.

Probably does, but active life styles have their own risks.