BS: medical insurance question

Subject: RE: BS: medical insurance question
From: katlaughing
Date: 14 Jun 08 - 12:30 AM

I miss your last posting, Janie. Seems I have good reason to be concerned and to hope like aitch the new pres and congress actually DO something.

Subject: RE: BS: medical insurance question
From: Janie
Date: 14 Jun 08 - 12:19 AM

PoppaGator,

I could not agree more.

We recently had an employee meeting with the representative of the insurance brokerage firm that worked with my agency to come up with the current arrangement. (And given current realities of the status of healthcare and healthcare financing in this country, I'll repeat myself and say it is pretty creative.)

The emphasis was on containment of health care costs and risk management. He made providers of health care out to be greedy bad guys. He did not realize he was addressing a room full of people who provide both public and private healthcare, all of whom had recently been out of work because of companies closing due to reimbursement rates that are inadequate to cover the cost of care, and none of whom gross more than $45,000 per year.

He wore a nice, expensive suit, and had a Coach bag for his laptop.

Not that he was a bad guy. And not that cost containment is not important. But it is only one half of the equation, and his paradigm rendered him absolutely unaware that half of the picture was missing.

Subject: RE: BS: medical insurance question
From: katlaughing
Date: 13 Jun 08 - 11:55 PM

When we were in WY, our costs, through Rog's employment, went up so much it was more than our rent. It made me mad and I said to take me off of it, which we did. We paid for all of my expenses. Still noen when we moved to Colorado until his company was sold to a BIG corp. They offered several different plans, still do, the choices being between how much deductible, co-pay, etc. We opted in as soon as it was available, one month after I'd been in hospital for life-threatening chf. The new insurance company has been really good...no problems re' pre-existing and they paid out over $250,000 for all of my pre-surgery and surgery costs when they put in a new heart valve. We have to pay too much as far as I am concerned, but they don't argue about paying, as long as the provider is in their network.

I do get concerned when I think of what is offered for retirees. My sister told me where she lives if you are on government insurance for seniors you will not get to see a physician, you will see a physician's assistant. THAT would bother me. Two PAs I saw last fall missed the pneumonia which landed me in the ER when my doc was out of town.

Sorry, didn't mean to digress. It looked as though you've already had your question answered and it feels good to *vent/share*.:-)

Subject: RE: BS: medical insurance question
From: Janie
Date: 13 Jun 08 - 11:46 PM

Again using my family as an example, simply because it is an absolutely typical scenerio. It could be almost anyone's story.

My parents both have Medicare and Medicare supplement policies. I'm guessing their retirement income is about $33,000 per year. Mom is 79. Dad is 83. Dad was able to work until early last fall to significantly supplement their retirement income, but had to finally stop for health reasons. At the same time, the downturn in the stock market has had significant impact on their retirement investments.

They each pay about $120 per month for the Medicare part B and D premiums. Mom pays about $300 per month for her Medicare supplement policy. Dad pays less because he can get some of his health care at the VA hospital. Mom had cardiac by-pass surgery a few years ago and has severe hypertension. Her medications cost $700 per month. They have just enough income to hit that Part D wall in prescription drug coverage along about July each year, so Mom's medications will have to be paid out of pocket for several months.

Dad needed a lift chair as he has great difficulty getting into a standing position. They bought one and are scrambling to get it paid for before Mom has to start paying for her prescriptions out of pocket.

There is now a shingle vacine out, and it is strongly recommended that elderly folks get the vacination. The vacine is expensive and medicare does not cover it. Having seen what my grandmother went through with shingles, Mom and Dad decided to get the vacine this spring. Dad, who suffers from debilitating chronic pain, is followed at the pain clinic where he gets epidurals for both hips and radio wave treatment for his neck. His back is beyond help. Most of the cost has to be paid out of pocket. He has delayed his next scheduled appointments at the pain clinic by 2 months for them to be able to pay for the shingles vaccine.

This is wrong. And it is a story that is told in more households of retirees than not in this country.

Subject: RE: BS: medical insurance question
From: Janie
Date: 13 Jun 08 - 10:53 PM

I"m using my personal circumstances as an example, because it is pretty typical of the situation here in the US.

I didn't start work for the agency until March of this year. They apparently had a BCBS plan previously. Then, last year, a couple of their employees had major and expensive illnesses that the insurance company had to shell out for. Companies must renegotiate premiums with insurers yearly. Because of the high usage of the insurance by employees last year, BCBS jacked up the rate they offered to the agency for this year. The agency couldn't afford it without passing on costs to employees at a rate they knew employees also couldn't afford.

The company I worked for until they closed shop in this region in February experienced a huge increase in their BCBS premium for 2008 and what I paid for family coverage increased from $210 per month to $430 per month. I was part of the reason for that huge increase. I had to have a complete cardiac work-up last summer which cost several thousand dollars. With the coverage I had, I paid just under $800 out of pocket and the insurance covered the rest of it.

When they laid me off, the cost to continue COBRA coverage for the family was $1056 per month. (For non-USA folks, COBRA coverage means a person who is laid off can keep their medical insurance under the group plan where you work for 12 -18 months, provided you pay the full premium at the private rate.) I kept the COBRA coverage for estranged hubby at a cost of $350 per month for this year.    Since he won't be 65 and Medicare eligible within the 12-18 timeframe, I am delaying the divorce, because once I divorce him, he becomes eligible for another 12-18 months coverage - if he can afford the premium.

Subject: RE: BS: medical insurance question
From: Gurney
Date: 13 Jun 08 - 09:56 PM

I'm assuming that the system we have here in godzone is similar, so think about this; When you reach retirement age, the payment required will start to increase, virtually annually, because they DON'T want your business. You will be on a pension and may be unable to sustain the increases, and you are much more likely to NEED medical treatment. Now the tricky bit.
They will NOT at this point change your policy to a hospital-only policy. Thay will only close that policy and begin a new one, Which will NOT cover existing medical conditions, even though the conditions developed whilst you were insured by them! Sneaky.

This has happened to me, and I now wish that I had realised it was going to, as I would have opted for the mimimum, hospital-only policy all the time. I would have been able to keep up the payments longer, and it was cheaper all the way through, anyway. My company made a virtually 90% profit out of me.

Do check the system your insurer operates.

Subject: RE: BS: medical insurance question
From: Sandra in Sydney
Date: 13 Jun 08 - 09:08 PM

I second your comment, McGrath, tho I don't know who to thank for our health cover

sandra

Subject: RE: BS: medical insurance question
From: Leadfingers
Date: 13 Jun 08 - 07:15 PM

Post Code Lottery aside , at least I can go to my Doc and get LOOKED at and a basic prescription without having to sell my house ! And at my age , prescription medecine is FREE !!

Subject: RE: BS: medical insurance question
From: McGrath of Harlow
Date: 13 Jun 08 - 06:53 PM

Strewth!!!

Thank you Nye Bevan and Clement Attlee!!

Subject: RE: BS: medical insurance question
From: Janie
Date: 13 Jun 08 - 05:50 PM

FYI, the small non-profit where I now work switched to an unusual arrangement this year in an effort to keep premiums affordable for them and for us. For the employee, they pay 100% of the premium for a catostrophic policy with a high deductible. Then, the agency has an HSA from which they will reimburse the employee the first $700 and the last $1300 of the $5000 deductible.    The employee does not contribute to the HSA. The catastrophic policy pays 100% of preventive care, and has a standard RX co-pay similar to most insurances.    After the deductible is met, it pays 100%. If I have no major illnesses that require expensive tests or hospitalization during the year, I'll probably be reimbursed for all out of pocket expenses from the HSA. If I do have major issues, I'll end up paying up to $3000 out of pocket.

The HSA covers the employee only. For my minor child, I decided to get a private BCBS policy with a standard $20 co-pay for office visits and a $1000 hospital deductible for about the same cost as I would have paid to include him on the catastrophic policy sans the HSA benefit.

It ain't a great situation, but is a pretty creative attempt by a small agency to come up with a way to be able to continue to offer insurance at affordable cost to it's employees.

Subject: RE: BS: medical insurance question
From: PoppaGator
Date: 13 Jun 08 - 05:37 PM

I'm surprised that a company with only 19 employees ever paid 100% of their health insurance costs. I've been either an employee or a co-owner of small businesses for my entire adult life ~ never worked for a mega-corporation ~ and shared healthcare cost between company and employee has always been my experience. In some cases, a company might pay 100% of the individual employee's coverage, but require the employee to participate in paying for spouse/family insurance.

Check out your alternatives; I doubt that you can do better all by yourself on the open market than what your employer is offering, even though they're offering decidedly less than they used to. Buying health insurance when you're not part of a "group" (which almost always means a group of employees of a single organization) is only only prohibitively expensive, it also usually involves tougher restrictions about "pre-existing conditions," etc.

The only REAL solution is a whole new system, of course. "Sicko" is not slanted or "propaganda" ~ it's flat-out accurate reporting (with a bit of showmanship thrown in). The insurance companies do everything they can to refuse coverage to anyone too likely to need it, and when a plan member does require help, especially in cases of serious illness and expensive treatment, they go to great lengths to avoid paying. Hey, it's business, right? The first priority is to take care of the shareholders, not the customers.

Also, of course, a very large portion of health-insurance payroll expenses (paid for by premiums, of course), goes towards efforts to deny coverage. That's why US residents/citizens get the least value for their healthcare dollar ~ we're paying lots of health-plan money for refusal to care, plus another big chunk of change for the expense of processing a gazillion different kinds of paperwork. People in the rest of the industrialized world pay almost exclusively for medical services when paying for health care.

Subject: RE: BS: medical insurance question
From: Janie
Date: 13 Jun 08 - 05:16 PM

The last company I worked for, I paid 50% for the employee coverage. I have had always to pay 100% of the premium for my family.

Subject: RE: BS: medical insurance question
From: artbrooks
Date: 13 Jun 08 - 05:00 PM

The health insurance program for Federal employees has a number of different options, almost all of which include a mixture of copayments and benefit caps. The employee share, depending upon the particular plan chosen, is somewhere between 25 and 30 percent of total cost, which can be anywhere between $100 and $300 per month for a family. With some exception, ancillary benefits like vision and dental are either extra or not available. This is, by the way, the same program that members of the House and Senate are under.

Take it and run.

Subject: RE: BS: medical insurance question
From: catspaw49
Date: 13 Jun 08 - 04:23 PM

Its the norm in most companies especially in family coverage. Karen carries ours and she works for a large, multi-state Catholic Hospital system. We have extremely good insurance with low or often no co-pays and a really exceptional prescription program. Including the Doctor and Hospital coverages and Vision/Dental.......the total %tage we pay is 22%.

Spaw

Subject: RE: BS: medical insurance question
From: dwditty
Date: 13 Jun 08 - 03:48 PM

Don't get me started! I work for a small company. I was paying 25% of my (employee) premium and 75% of the family portion. This was a copay plan requiring $25-35 per office visit ($35 for specialist) and $10-$40 for prescriptions. Pretty lousy plan. Had I elected to stay on the same plan this year, my out of pocket would have been over $16,000. Outrageous! Before you say, "Get another job," I have been trying for a while and wll continue to do so. I switched to an HSA plan where I pay 100% of the first $3000, then the plan kicks in. This should only cost me $11,000 out of pocket including my portion of the monthly premium! If you have a deal for 20-25% of the premium, take it. It is a great deal compared to what many of us pay.

Rent Michael Moore's Sicko. I know Michael is the flip side of Rush Limbaugh politically, but it does make you wonder why the USA ranks number 37 in the world in quality of healthcare.

...steps off soap box.

Subject: RE: BS: medical insurance question
From: irishenglish
Date: 13 Jun 08 - 03:39 PM

Thanks everyone! Because of other crap going on at this company, my, along with others reaction to this news was-You gotta be kidding me! From what you are all saying, it doesn't seem to be unheard of, so that's my answer then. Thank you again

Subject: RE: BS: medical insurance question
From: Becca72
Date: 13 Jun 08 - 03:34 PM

I work for a hospital and pay 20% of my insurance. 25% is not unreasonable.

Subject: RE: BS: medical insurance question
From: John on the Sunset Coast
Date: 13 Jun 08 - 03:26 PM

Unless you can find comparable (or better) insurance on your own, participate in this plan. Also consider these thoughts.

1) Remaining with this plan automatically keeps your insurance in force. If you go to another plan, you may get limited coverage or prohibitively costly coverage if anyone in your family has health problems, or no coverage at all.

2) If you change plans you may have to change long time associations with physicans.

3) If all are in good health, you might get lower cost catastrophic care coverage, and assume the cost of routine services on your own.

The above are suggestions from the Joy of my live who was, indeed, an insurance benefits counselor with a major employer for 10 years.

Subject: RE: BS: medical insurance question
From: Stilly River Sage
Date: 13 Jun 08 - 03:25 PM

You're bound to have a lot more in the package if you're part of a group that is insured than if you strike out on your own to get personal insurance, so the 25% you're being asked to pay now costs way less than a personal plan and probably gets you more from the plan.

The offerings of insurance with employment vary so greatly that it really doesn't offer you much help to describe the plan with my employer, except to remark that as a public employee it has been my experience that better insurance is usually tied to lower general pay in the marketplace.

SRS

Subject: RE: BS: medical insurance question
From: irishenglish
Date: 13 Jun 08 - 03:18 PM

No, all of your opinions are worth something, so thanks. I am going to keep the insurance, I guess I should have just asked is 25% too high. It would be stupid of me to get rid of it.

Subject: RE: BS: medical insurance question
From: Melissa
Date: 13 Jun 08 - 03:16 PM

Having insurance is way better than not having it..especially if the coverage is good with very small co-pay.

I don't think it's uncommon for employees to pay a percentage of their ins--I've heard several people talking about 'their part' being 50%..so 25% doesn't seem overly bad to me.

Insurance rates are going up and there are a lot of changes being forced on ins companies at the moment.
I think it would be reasonable to view your company's new thing about you paying part of the premium as being their way of trying to not get gouged by sudden price hikes..unless you have other information.

If you keep insurance now, it will be easier to have insurance later if you need it--even if you need to switch providers later for some reason.

That's my semi-informed opinion and may or may not be worth anything.

Subject: RE: BS: medical insurance question
From: GUEST,mg
Date: 13 Jun 08 - 03:14 PM

Take the insurance. mg

Subject: BS: medical insurance question
From: irishenglish
Date: 13 Jun 08 - 03:07 PM

Had a question for anyone who is particularly knowledgeable about US company provided medical insurance. My company, which has 19 employees just sent out a notice that if an individual wants to maintain their coverage, we will be required to pay 25% of the overall premium. So the options are, no insurance, or pay 25%. Now, I don't want to state my salary publically here, but let's just say that amount that I would have to pay is "do able", but would be somewhat of a burden, when one adds up what that is over the course of a year. First thing when I found out, and which others have told me is-no question, the company is floundering, and although not imminent, is in danger.

So, does anyone else pay in that much in their health plan? Should I suck it up, find a way to make it work? Having insurance way better than not having it?