I hate health insurance changes

[cabanafrau]

Sure it is. But the topic of this thread isn't Canadian Health Care versus U.S Health Care. That's all...and yes, it can get heated so why??

In the course of this thread someone posted their experience and I posted mine. As I stated previously, I haven't seen the "heated" threads & I even suggested perhaps a sticky might be beneficial to prevent further offense.

Anything else you feel I shouldn't discuss that I might be unaware of?

 

[ilovemk76]

Has anyone had the "new laws" affect them positively? Thanks to the Affordable Care Act, which requires insurers to send policyholders refunds in any year during which they spend less than 80 percent of premium dollars on actual medical care, I got a refund check of about $450.00 from my insurance company. I can't be the only one, can I?

I have not and nobody I know has either. This year our insurance company has spent $80 on us. Last year the total was the same amount.

 

[EMAW_KSU]

My dh is self employed and we pay very high premiums for high deductible health insurance. During the last policy year dh went to the doctor twice, dd once and ds did not go at all. We got a letter saying that there would not be a refund. I don't think they even paid out enough to equal one month's worth of premium. I don't get it.

I do not either. If the companies have to refund money to people that did not use at least 80% of their premium how are they going to pay for the person that used 100 times their premium?

 

[KBoopaloo]

I do not either. If the companies have to refund money to people that did not use at least 80% of their premium how are they going to pay for the person that used 100 times their premium?

I may be wrong, but I believe it is not your use of the plan specifically but the use of the entirety of people with the type/group of plan you have? So if everyone in the group plan you are in used less than 80% of the premium, everyone in that group gets a refund. I know at my employer, we were sent a check for a lump sum and it was divided equally between the employees, it was not doled out based on actual individual usage of the insurance. If it were, I would have gotten the whole check.

I also think that the "group" of the plan you are in is not limited just to your employer but consists of users in that group across the board.

Again, I could be completely off base but that was the way it was explained to us at work. And maybe it varies from state to state, I have no idea.

 

[Cannot_Wait_4Disney]

Originally Posted by EMAW_KSU View Post
I do not either. If the companies have to refund money to people that did not use at least 80% of their premium how are they going to pay for the person that used 100 times their premium?

The 80% figure is on the whole, not individually.

Originally Posted by Laugh O. Grams View Post
Has anyone had the "new laws" affect them positively? Thanks to the Affordable Care Act, which requires insurers to send policyholders refunds in any year during which they spend less than 80 percent of premium dollars on actual medical care, I got a refund check of about $450.00 from my insurance company. I can't be the only one, can I?

We got one. Wooohooo!!! But I'd hope in the future, we don't get one and that the insurance company is keeping its administrative costs and executive salaries in check. And it hasn't affected us yet, but being able to carry our children through their college years is going to be a huge huge plus for us.

 

[Phil'sFrontier]

Sorry people I did not mean to get into an argument on the internet, I mean who does that???
I just think it is really unfair to hear about how a lot of Americans struggle with health care cost that just keep rising.
We need more teachers, come live here

 

[bedogged]

Just wait until teachers, state and federal workers are told that there will be no health care benefits after retirement. The private sector has already started this a few years ago and within the next few years, I doubt there will be any of those benefits at retirement.

At the company I'm at, you retire with no health care benefits - that will be one factor in EVER retiring at all. People I've spoken to are paying anywhere from $1000 and up per month on premiums after retirement.

Same for us. Cobra would be over $1,000, but that only lasts 18 months. Our problem is that I am younger and after the 18 months I will not have medicare. Our insurance of over 30 years has already said that they will not take me at any rate because I have preexisting conditions. So spouse gets medicare and I get nothing? My only hope is that if the law continues as it is, in 2014 insurance companies cannot discriminate based on preexisting conditions of adults. I believe that law already applies to children.

 

[ilovemk76]

Same for us. Cobra would be over $1,000, but that only lasts 18 months. Our problem is that I am younger and after the 18 months I will not have medicare. Our insurance of over 30 years has already said that they will not take me at any rate because I have preexisting conditions. So spouse gets medicare and I get nothing? My only hope is that if the law continues as it is, in 2014 insurance companies cannot discriminate based on preexisting conditions of adults. I believe that law already applies to children.

I am surprised your insurance is that way. We pay our own plan and we asked what happens when the older one turns 65 and has to go on medicare as the primary. We were told that the younger one stays on the plan as an individual and the older person's converts to a supplemental. When the other ages in, then they join the older one on the supplemental plan.

 

[disney1990]

No new laws here in Maryland that have affected what our copays are for prescriptions or doctor visits. We have had the same copays for many years now.

 

[bedogged]

I am surprised your insurance is that way. We pay our own plan and we asked what happens when the older one turns 65 and has to go on medicare as the primary. We were told that the younger one stays on the plan as an individual and the older person's converts to a supplemental. When the other ages in, then they join the older one on the supplemental plan.

That is because you already pay for individual insurance. We are covered under my spouse's work paid for group insurance. The problem occurs when we try to buy the same plan for ourselves. If you belong to a group, they HAVE to take you. When you are buying for yourself, they, as of now, can pick and choose who they take.

 

[disney1990]

It is the health insurance company as a whole.

" If an insurance company spends less than 80% of premiums on medical care and quality (or less than 85% in the large group market, which is generally insurance provided through large employers), it must rebate the portion of premium dollars that exceeded this limit.[1] This 80/20 rule is commonly known as the Medical Loss Ratio (MLR) rule."

In some cases, the money will be refunded to the employer, not the employees. But there is something in the law about the money then being spent to benefit the employees.

 

[ilovemk76]

That is because you already pay for individual insurance. We are covered under my spouse's work paid for group insurance. The problem occurs when we try to buy the same plan for ourselves. If you belong to a group, they HAVE to take you. When you are buying for yourself, they, as of now, can pick and choose who they take.

Ours is not an individual plan but a group plan. The plan is in my DH's name and I am covered under it.

 

[Luv'sTink]

I am Canadian. I am lucky to live in a place where my health care is very well done. If I go to the doctors or the hospital all I do is show my Yukon health care card. We don't have any monthly payments unless you have extra insurance to cover prescriptions or something.
But if you need to go to er or have a baby or get your child into the doctor, all that stuff is covered by government health care.
There are a lot of myths about long line wait times, and quality of care, most of which are untrue.

Hmmm, Vancouver must be the exception then. My sister in law paid $500 out of pocket to get her MRI so she didn't have to wait a year. And I wonder why my father in law would tell me to call up my President and tell him we don't want Canadian medical. Strange, really strange.

 

[Swan4Me]

Its a new state law.
And yes we have been spoiled, but it still doesn't make it any easier. Thankfully my mom is about to retire.
Its a harder blow for her considering shes basically been a single mom our entire lives with not a single amount of support. She's amazing. But this newest change has her stressed to the max.

How is retiring going to help?

 

[chobie]

Hmmm, Vancouver must be the exception then. My sister in law paid $500 out of pocket to get her MRI so she didn't have to wait a year. And I wonder why my father in law would tell me to call up my President and tell him we don't want Canadian medical. Strange, really strange.

Maybe just unusual. Don't seem to hear a majority of Canadians demanding a health care system like ours.

 

[tvguy]

My dh is self employed and we pay very high premiums for high deductible health insurance. During the last policy year dh went to the doctor twice, dd once and ds did not go at all. We got a letter saying that there would not be a refund. I don't think they even paid out enough to equal one month's worth of premium. I don't get it.

Well, I think you hit on another part of the problem. What did your Doctor bill the insurance, and what did they pay? I went to see a specialist, and he billed my insurance $800.......mine you he spent 5 minutes with me. Now, the contracted amount he finally was paid was reduced to $500......but, $500 for 5 minutes for a specialist........for a condition that 20 years ago my primary care Doctor would have handled himself for no additonal fee.

 

[Colleen27]

Yup, that's what a lot of people seem to be ignoring. Public sector jobs have generally been lower paid than in the private sector. It was the benefits that made these jobs attractive. As benefits are being erroded they are becoming more in line with the private sector but not the salaries are still lower.

Generally speaking of course.

Yep. And the way they've rationalized it is by moving the bar... Instead of looking at comparable educational attainment, they focus on specific majors. Never mind that a major in education or social work or anything along those lines applies primarily to the public sector, and that the students choosing those fields are spending just as much on their education as the ones getting degrees in accounting and computer science.

 

[Callie]

Yup, that's what a lot of people seem to be ignoring. Public sector jobs have generally been lower paid than in the private sector. It was the benefits that made these jobs attractive. As benefits are being erroded they are becoming more in line with the private sector but not the salaries are still lower.

Generally speaking of course.

Exactly, my mom decided to work at an inner city school with rough kids because of the benefits. She could breezed through the years but stuck it out! These kids don't even call her Mrs (last name)
Its MISS! Hey Miss!

 

[denisenh]

Yep, and DH is a state empoyee and has our states "teacher's" insurance.

Stinks--lots of premium increases and high deductibles with Dr visits of $150 out of pocket. There have been many years where the insurance increased and pay didn't.

We are not "sickly" people and do not go to the dr. unless it is very serious for these reasons.

Hopefully, something will change in our healthcare system soon.

We had an overview of our new health insurance at work. It starts at a $500 deductable per individual across the board (but it goes as high as $10,000 out of pocket max for a family) and it all depends on which doc you see and where.
Anyway, DH and I see doc once a year for our physical, we stay in network. So we pay about $600 a month for insurance and still pay for our dr visit completely because all we do is get a checkup.
I know I shouldn't complain. We are healthy, knock on wood. Insurance is for "just in case", like our auto , life and homeowners insurace. We pay it but don't have claims.

Insurance deductables should work the other way. Pay claims up to $500 (or even a lower amount) a year in full and THEN have out of pocket kick in up to whatever amount deductable before it pays out again. That way the light users get some benefit.

re: bolded. many non state employees deal with wage freezes and hour/pay cuts along with rising costs of everything and yes, it rots. our home budget has had many redos as of late..adjusting to make it work.

 

[FayeW]

Hmmm, Vancouver must be the exception then. My sister in law paid $500 out of pocket to get her MRI so she didn't have to wait a year. And I wonder why my father in law would tell me to call up my President and tell him we don't want Canadian medical. Strange, really strange.

I think it is wonderful that your sister in law had the option of paying $500 and having the MRI immediately. To put it in perspective, it might have cost her 10 times that amount in insurance premiums to have that in the US.

The issue on this thread is not American vs Canadian health care. It's that the OP's mother has less coverage and higher deductibles than she had before, and it's costing her more for the privilege. What somebody else has or pays is irrelevant to the OP...her mother now has a smaller budget to work with than she had before and she is venting.