Help! My health Ins is about to double!

[youbet]

Even with a PPO dermatologist appointment wait times can be 3 months in my part of the U.S.

As another point of reference, I just made a dermatologist appointment Monday of this week. It's for Thursday of next week. So, ten days. I think there is a lot of variation depending on many factors.

Comparing health care systems seems so complicated. I, and generally the people around me, all had employer provided comprehensive health insurance while we worked and in pre-65 retirement. At 65, we switched to Medicare Part A + Part B + Part D + F Supplement. Costs never seemed outrageous. Quality seemed good, especially if you were willing to research and shop. But I'm well aware that many others have had to rely on Medicaid and emergency rooms. Not a good thing.

I'm really not sure where we should go from here. I do know that the USA tends to be much more multi-cultural than most of the countries with single payer systems such as the UK, Canada, the Nordic countries, etc. Finding common ground as to what a new medical care system should look like isn't going to be easy. Should it be something that gives everyone only catastrophic coverage? Or maybe complete cradle to grave coverage for all possible needs?

I wonder as the Baby Boomers continue to swell the ranks of Medicare and as Medicaid expands if that might make the path forward easier to see? If much of the USA population is on gov't insurance anyway, might the transition to everyone being on gov't insurance be more straight forward?

 

[travelover]

Stephen Brill wrote a great article on heath care costs in the U.S. for Time, called Bitter Pill: Why Medical Bills Are Killing Us

Bitter Pill: Why Medical Bills Are Killing Us - TIME

............

Interestingly, in a follow up article in Time, Brill proposes having hospital systems sell health care insurance as well as provide services, on the theory that it would force efficiency in delivering services. I can see that either working or going terribly wrong depending on what external forces, like regulation and competition, dictated.

At MegaMotors we had areas with conflicting objectives - like emissions and fuel economy, under a single manager and it worked quite well. But there was someone overseeing the whole process and failing or coming up with a super expensive solution was not an option.

 

[MRG]

Part of the runaway costs is incompetent staff. DW went to PCP two weeks ago. Since then she's been to urgent care for a steroid injection for the reaction to the antibiotic doc gave her. Another prescription for steroids, now we're in the ER at her docs suggestion. Their redoing the tests her Doc may have done. It's time for a new Doc, her answer of "I don't know what's wrong with you, and we're too busy" while possibly true is not really acceptable.

 

[athena53]

Just in from a French news podcast I'm watching: a group of docs in one area of France is in strike- not the first time I've seen this happen. This time they're protesting what they see as too much control by the government over how they treat patients.

We have a lot of problems in the US but I've never seen doctors go on strike.

 

[W2R]

Even with a PPO dermatologist appointment wait times can be 3 months in my part of the U.S.

My PPO experience has been similar at times. I had to wait 2 months to see my ophthalmologist/surgeon so that he could see if I needed cataract surgery (I did, and had it in October).

I suppose I could have seen SOME ophthalmologist sooner, but no way! These are my eyes and I refused to let anyone but the very best carve into my baby blues (ewww! shudder).

Probably everyone else was thinking the same thing and that is why he's so booked up.

 

[zenzy]

Any suggestions??

The suggestions to get a Bronze plan or hardship exemption qualified Catastrophic plan make sense to me.

By the way, I got free help from a certified assistance location because they always know things about the ACA that I didn't but needed to know.

DawgMan come back.

 

[EastWest Gal]

Didn't read all the answers but just wanted to throw in 2 cents. If you buy the HSA compatible plan, you can put up to $6,600~ in per family. That will reduce your MAGI by that amount which might be enough so that your insurance doesn't double. We are in the same boat. I'm switching now from grandfathered "non obama" plan to a new one, but our income is 3-4k from the line where our premiums will go from $407 to $858. We are also self employed and have SIMPLE retirment plans but will switch to SOLO 401k's if needed to reduce taxable income further.

In another thread, it was explained that if you qualify for a premium subsidy, then you can't qualify for an HSA plan. The point of the subsidy is to help those who can't afford the premiums. If you knock down the MAGI by putting money into an HSA, then the US government has figured out that you can afford the premiums. In other words, since premium subsidies come from taxpayer money, you can't ask the rest of us to fund your HSA account. So you might want to look into Solo 401Ks, since that plan won't fly.

Here's the link to the other thread. It's very recent:

http://www.early-retirement.org/forums/f38/hsa-silver-plan-with-cost-sharing-big-trouble-79380.html

 

[cyber888]

... maybe I am just a rich bastard who needs to be taxed more!! Any suggestions??

The pricing scheme of the healthcare system has identified you as such . You're probably still better off than 97% - 98% of the rest of the US population in terms of networth and income. In short, 97% - 98% of the population will still prefer to be in your situation (paying double) and have your networth.

 

[daylatedollarshort]

Any suggestions??

If your income is somewhat malleable and you are not too far off from the ACA cliff you can do what you can to get under it - cut expenses, defer expenses, take after tax money out of your home equity and pay it back later (if the interest charges are less than subsidy amounts), maybe try to get the subsidies every other year, look for more business expenses, max out your retirement accounts, etc.

 

[EastWest Gal]

One other thing about the first post. It just didn't seem right. I looked up OP's state, and he's in a state that uses the federal exchange. Well, since my premium went up 10%, I figured his couldn't have been too far off. I was able to look up the 2015 premiums and the 2016 premiums and, I just calculated premium increase. For the lowest cost plan it was 9.7%, for the highest gold plan available both years its was 17.4%. So I'm not sure what the OP was looking at, but it doesn't sound like it was the same plan. I can't accept the original statement at face value, after having done a little research. Perhaps he made a mistake.

 

[cyber888]

I lived in Denmark for 4 years. You just set an appointment a visit a doctor or specialist, and there are no co-pays (as in ZERO cost). And if you need blood work or lab analysis, a brain scan, etc ... everything has zero costs. When I lived in the UK, a British guy would just go to the pharmacy and ask for an inhaler for his asthma, and never paid anything.

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.

 

[travelover]

One other thing about the first post. It just didn't seem right. I looked up OP's state, and he's in a state that uses the federal exchange. Well, since my premium went up 10%, I figured his couldn't have been too far off. I was able to look up the 2015 premiums and the 2016 premiums and, I just calculated premium increase. For the lowest cost plan it was 9.7%, for the highest gold plan available both years its was 17.4%. So I'm not sure what the OP was looking at, but it doesn't sound like it was the same plan. I can't accept the original statement at face value, after having done a little research. Perhaps he made a mistake.

Wasn't the OP coming from an underwritten plan to the ACA exchange?

 

[pb4uski]

.....The notion that health care should be linked to one's employment or employer benefits is completely foreign to us. .....

The linkage of health insurance with employment that is one of many dysfunctions in our system is an unintended consequence of a previous government intervention of not allowing pay increases so employers chose to attract and retain employees by offering them health insurance that was not prohibited.

Many of us would like to see the link between health insurance and employment be eliminated but taking away a cherished benefit that isn't currently taxed or convincing employers to make employees whole is tricky politically.

 

[Mr._Graybeard]

In another thread, it was explained that if you qualify for a premium subsidy, then you can't qualify for an HSA plan. The point of the subsidy is to help those who can't afford the premiums. If you knock down the MAGI by putting money into an HSA, then the US government has figured out that you can afford the premiums. In other words, since premium subsidies come from taxpayer money, you can't ask the rest of us to fund your HSA account. So you might want to look into Solo 401Ks, since that plan won't fly.

Here's the link to the other thread. It's very recent:

http://www.early-retirement.org/forums/f38/hsa-silver-plan-with-cost-sharing-big-trouble-79380.html

The HSA conflict is with the cost-sharing benefit, not the subsidy.

 

[sengsational]

The HSA conflict is with the cost-sharing benefit, not the subsidy.

Right. If you have copays and coinsurance kicking in the low range, then it's not a high deductible plan as defined by the IRS. PTC isn't part of that equation.

 

[EastWest Gal]

The HSA conflict is with the cost-sharing benefit, not the subsidy.

Thank you. I stand corrected.


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[EastWest Gal]

Wasn't the OP coming from an underwritten plan to the ACA exchange?

He just said "like many here, he is losing his health plan this year" (paraphrasing). But he says he's self employed. He really didn't say.


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[travelover]

He just said "like many here, he is losing his health plan this year" (paraphrasing). But he says he's self employed. He really didn't say.

I think this is what he said:

Yes! It was an underwritten plan and I understand that there are certain groups (i.e. Pre existing conditions, those who qualify for ACA credits), I just frankly haven't run into anyone yet who is happy about ACA. ..............

 

[audreyh1]

I guess he had a grandfathered plan, but it is still going away? So the grandfathering did not last?

 

[Calico]

Prior to Obamacare, you might not have been able to get insurance at ANY price if you had had even a small health event. It didn't take much to get denied coverage on the individual market. Guaranteed access to coverage is a godsend to many.

^^^^This.

Many here would not even be able to retire early without the ACA and removal of the pre-existing conditions clause. How many households with adults ages 40 - 50+ do not have at least some medical condition they would have been denied coverage for in the past, like high blood pressure? Ironically, a friend of ours with medically controlled high blood pressure had to go back to work and cut his ER plans short when he could not get health insurance at any price, pre-ACA.

^^^^And this.

 

[ziggy29]

I guess he had a grandfathered plan, but it is still going away? So the grandfathering did not last?

A plan can remain grandfathered indefinitely if it doesn't substantially change the coverages or the cost sharing.

https://www.healthcare.gov/health-care-law-protections/grandfathered-plans/

Can a plan lose its grandfathered status?

Yes. Plans can lose their grandfathered status if they make certain changes that lower your benefits or increase your costs.
In order to keep their grandfathered status, plans can't:

Significantly cut or lower coverage
Raise coinsurance of the allowed amount for the service
Significantly raise copayment charges
Significantly raise deductibles
Significantly lower employer contributions
Add or tighten a yearly limit on what the health plan pays

So we're seeing more and more grandfathered plans just going away, because they can't meet the criteria above in any way that keeps it remotely affordable.

 

[NW-Bound]

... So we're seeing more and more grandfathered plans just going away, because they can't meet the criteria above in any way that keeps it remotely affordable.

In addition, grandfathered plans for individuals cannot enroll new people. Having its pool of the insured shrinking due to attrition is another reason for a grandfathered plan to be shut down by the insurer.

 

[Ian S]

In addition, grandfathered plans for individuals cannot enroll new people. Having its pool of the insured shrinking due to attrition is another reason for a grandfathered plan to be shut down by the insurer.

I think that last part is key: grandfathered simply means that the plan can continue to be offered; it doesn't mean it HAS to be offered. The insurer is free to terminate it if it wishes.

 

[GTFan]

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?

We are in this exact boat now - while vacationing in DC last month my wife fell and broke her femur (closed fracture). Luckily the ambulance sent us to a hospital in-network for Humana, unluckily the surgeon that fixed it next day was out-of-network. So Humana paid the net $50k hospital bill for a 5 day visit (we pay the $6300 in-network deductible) and is not paying the reasonable $5800 bill for the surgeon.

Needless to say we immediately appealed the OON decision since the surgery was medically necessary and she could not have traveled, and the hospital made the decision to keep her and assigned the doc to do the work. So even if Humana denies appeal we are going to call the hospital and ask them to work it out between insurance and doc since it was entirely their call. Fortunately we have a letter from the surgeon backing our appeal claim about medical necessity (he's a great guy) but we'll see how it goes.

 

[ziggy29]

I think that last part is key: grandfathered simply means that the plan can continue to be offered; it doesn't mean it HAS to be offered. The insurer is free to terminate it if it wishes.

Precisely. And as a group ages (remember, you can't add new members to a grandfathered plans, so the group gets older every year), the insurer will eventually want to drop it because they can no longer offer it at a price anyone will pay, especially with the ACA eliminating medical underwriting and preexisting condition exclusions.