Katsmeow
Give me a museum and I'll fill it. (Picasso) Give me a forum ...
- Joined
- Jul 11, 2009
- Messages
- 5,308
I've talked a little bit about this in other threads, but wanted to do a separate thread about how our retiree health insurance has changed. For 2016, the big change has been made. DH's former employer had been providing subsidized coverage for a group PPO plan. For 2016, we have been moved to the individual health insurance market with Megacorp paying a substantial share of the premium.
DH retired from Megacorp about 5 years ago. He was in a group of employees entitled to subsidized retiree coverage. When he retired, the coverage covered him, me, and our kids.
Megacorp's share of premium increases was limited to (I think) 5% per year. This was a good PPO plan with the typical broad network. This was a high deductible plan with a family deductible of $3000.
Over the years monthly premiums started going up.
2011 - $289
2012 - $289 until DH went on Medicare and then it dropped to $180.
2013 - $479
2014 - $780
2015 - $842
Obviously the last 2013 and 2014 premium increases were surprising, especially the increase in 2014. At the end of 2014, Megacorp said that had they simply applied the % limitation there would have been another large increase for 2015. However, they elected not to do that so we had a small increase. They also said they were looking at other options including a private exchange where you could buy plans and by being in a larger group could get better rates.
At the time this seemed reasonable to consider. As the retiree plan was getting more and more expensive I was thinking people might start jumping from it. So being able to be in a larger group didn't sound bad.
Of course, I was thinking this would be in a larger group that would be buying group coverage.
A few months ago Megacorp wrote us and said they were going to go the private exchange route. Significantly, they said we could buy similar coverage at more affordable rates.
Again, that sounded OK.
About a month ago, we were told about the private exchange and were told that there would be larger risk pools so we could have affordable coverage comparable to what we have now through Megacorp.
They said they would give a specific amount as a Health Reimbursement Arrangement. The amount itself was fine. It wouldn't cover everything but would cover a lot of the premiums. The one negative is that it increases according to CPI, capped at 2.5% per year. Obviously that isn't great since premiums go up more than CPI.
Still, I didn't think it was that bad. At no point, in any of the letters did Megacorp say that what was really going on was that they were putting us on the individual market to buy whatever plans would be sold to the general public. We would no longer have access to group plans.
Once I could log into the private exchange it became clear that what we were being offered were the ACA exchange plans plus other non-exchange plans offered to the individual market.
The result is that our premiums are going to be less in 2016, but the coverage is not remotely comparable.
I had a plan with a very broad network (including MD Anderson if I was to get cancer). The family deductible was $3000 and the OOP max was $7000. The out of network deductible was $7000 (I don't remember what the OOP max is).
After scouring all the plans available in my area, nothing is remotely similar. The best plan I've found is a Cigna EPO. There are no PPOs in the Houston market. There are no plans that have MD Anderson in network. Most plans have tiny hospital networks.
The Cigna EPO actually has a decent hospital network (with the exception of not having MD Anderson). The family deductible for the plan we will likely choose is $12800 with an OOP of $13400. There is no out of network coverage at all (except emergencies).
Even though our share of the the premiums will be lower than our premiums before the overall cost to us will likely be thousands of dollars more given the high deductibles, not to mention the lack of out of network coverage.
DH and I did talk to Megacorp about it. They expressed surprise at the lack of PPOs in Houston. I don't think that they anticipated it would shake out that way. I would guess that when they made the decision to do this, they thought that there would be PPOs available. But, the reality is that they aren't.
When the ACA went into effect, I predicted to my Houston that Megacorp would eventually do this. Why continue to provide group coverage (Megacorp has historically self-funded coverage) when retirees can get coverage now from the individual market. It is way easier for Megacorp to simply subsidize those premiums. And, if PPOs comparable to our current PPO existed in the individual market -- even at higher cost -- I would be OK with it. As it is, I am not remotely happy about it.
I know I should be happy to be able to have any retiree insurance at all, especially subsidized retiree insurance. And, I am happy about that.
Still, it doesn't make me happy that my coverage choices are so limited now and that I have absolutely no option for a PPO with out of network coverage.
I will be eligible for Medicare in 3 1/2 years so hope that I can make it to then without this whole out of network thing causing problems. And, I hope that we 2017 there will be better options.
I just wish Megacorp had continued to offer the group PPO as an option even if the premiums would have been higher.
DH retired from Megacorp about 5 years ago. He was in a group of employees entitled to subsidized retiree coverage. When he retired, the coverage covered him, me, and our kids.
Megacorp's share of premium increases was limited to (I think) 5% per year. This was a good PPO plan with the typical broad network. This was a high deductible plan with a family deductible of $3000.
Over the years monthly premiums started going up.
2011 - $289
2012 - $289 until DH went on Medicare and then it dropped to $180.
2013 - $479
2014 - $780
2015 - $842
Obviously the last 2013 and 2014 premium increases were surprising, especially the increase in 2014. At the end of 2014, Megacorp said that had they simply applied the % limitation there would have been another large increase for 2015. However, they elected not to do that so we had a small increase. They also said they were looking at other options including a private exchange where you could buy plans and by being in a larger group could get better rates.
At the time this seemed reasonable to consider. As the retiree plan was getting more and more expensive I was thinking people might start jumping from it. So being able to be in a larger group didn't sound bad.
Of course, I was thinking this would be in a larger group that would be buying group coverage.
A few months ago Megacorp wrote us and said they were going to go the private exchange route. Significantly, they said we could buy similar coverage at more affordable rates.
Again, that sounded OK.
About a month ago, we were told about the private exchange and were told that there would be larger risk pools so we could have affordable coverage comparable to what we have now through Megacorp.
They said they would give a specific amount as a Health Reimbursement Arrangement. The amount itself was fine. It wouldn't cover everything but would cover a lot of the premiums. The one negative is that it increases according to CPI, capped at 2.5% per year. Obviously that isn't great since premiums go up more than CPI.
Still, I didn't think it was that bad. At no point, in any of the letters did Megacorp say that what was really going on was that they were putting us on the individual market to buy whatever plans would be sold to the general public. We would no longer have access to group plans.
Once I could log into the private exchange it became clear that what we were being offered were the ACA exchange plans plus other non-exchange plans offered to the individual market.
The result is that our premiums are going to be less in 2016, but the coverage is not remotely comparable.
I had a plan with a very broad network (including MD Anderson if I was to get cancer). The family deductible was $3000 and the OOP max was $7000. The out of network deductible was $7000 (I don't remember what the OOP max is).
After scouring all the plans available in my area, nothing is remotely similar. The best plan I've found is a Cigna EPO. There are no PPOs in the Houston market. There are no plans that have MD Anderson in network. Most plans have tiny hospital networks.
The Cigna EPO actually has a decent hospital network (with the exception of not having MD Anderson). The family deductible for the plan we will likely choose is $12800 with an OOP of $13400. There is no out of network coverage at all (except emergencies).
Even though our share of the the premiums will be lower than our premiums before the overall cost to us will likely be thousands of dollars more given the high deductibles, not to mention the lack of out of network coverage.
DH and I did talk to Megacorp about it. They expressed surprise at the lack of PPOs in Houston. I don't think that they anticipated it would shake out that way. I would guess that when they made the decision to do this, they thought that there would be PPOs available. But, the reality is that they aren't.
When the ACA went into effect, I predicted to my Houston that Megacorp would eventually do this. Why continue to provide group coverage (Megacorp has historically self-funded coverage) when retirees can get coverage now from the individual market. It is way easier for Megacorp to simply subsidize those premiums. And, if PPOs comparable to our current PPO existed in the individual market -- even at higher cost -- I would be OK with it. As it is, I am not remotely happy about it.
I know I should be happy to be able to have any retiree insurance at all, especially subsidized retiree insurance. And, I am happy about that.
Still, it doesn't make me happy that my coverage choices are so limited now and that I have absolutely no option for a PPO with out of network coverage.
I will be eligible for Medicare in 3 1/2 years so hope that I can make it to then without this whole out of network thing causing problems. And, I hope that we 2017 there will be better options.
I just wish Megacorp had continued to offer the group PPO as an option even if the premiums would have been higher.