Anyone Else Worried About Health Premiums Going UP?

[manning]

I agree that insurance needs reforming, but to me this is a step in the right direction. There's a reason every single developed nation in the world except ours has some for of universal, single-payer health care... Because for-profit health insurance is a broken model from the ground up. It adds an additional layer of cost (profit and operating expenses for the insurance company), a massive amount of complexity for health-care providers (compliance with a different billing system for each insurance company they accept), and can only detract from the quality of patient care (because paid claims erode profits).

As far as the Medicaid expansion, it only covers people up to 133% of the poverty level. Those people should have been eligible all along. Call it socialism if you like, but one of the hallmarks of a developed society is some measure of protection for its most marginal, and proper medical coverage has the potential to save a great deal of money on other programs (ie disability, which many people pursue as a way to get medical care).

And when it comes to the national debt, I don't think it should be balanced on the backs of the poor, elderly, and children. We can afford billions upon billions in aid to countries around the world and lifetime benefits for so-called leaders who are wealthy before they take office and serve only a fraction of the time it would take to earn retirement and health care in any other job, and perpetual war on multiple fronts, but we should eliminate programs that give our poor access to health care and food? That is a priorities issue, not a debt issue.

Read this. You may or may not find it interesting.

 

[crisi]

Crisi answered some of the questions, but I'll answer with what my employer does. I believe to have an HSA you have to have a High Deductible Health Plan (HDHP). The deductible on our plan is $1500 per person or $3000 per family. Once we reach our deductible, the insurance covers everything 100%, including prescription drugs. So, in a year the most we would have to pay is $3000, that is the minimum we try to keep in our HSA.

My HDHP is a PPO that covers routine appointments 100% (I don't have a copay). When I go to the Dr. I show my insurance card. They bill the visit through insurance and then I get a bill. If it's a routine appointment, I get a bill for $0. If it's something else, the bill is discounted per the agreement with the insurance company, I get billed for the remaining amount. If it's a smallish amount, I usually pay it with our checking account, not the HSA (but it still gets applied to the deductible). That's what I mean when I say we try not to use it. And yes, most things are not covered until we reach the deductible. Prescriptions are the worst, but I shop around to find the best deal. You'd be amazing at how much drug prices vary at different stores. Most pharmacies have prices online so it's fairly easy to compare.

I work for a wonderful company that decided to pay 100% of the premium for anyone electing the HDHP instead of the 'standard' insurance plan. This allows me to take the money I would normally spend on premiums and put it into my HSA. This year, someone (with a family) electing to use our regular plan would pay $4,152/year in premiums and still have to pay a co-pay for visits and prescriptions. On top of that, they would have a $500 deductible, then the insurance would cover 90% until the family paid $2000 (not including co-pays), after that 100% would be covered. So, worst case scenario with the regular plan would cost a family $6,152 (not including co-pays). Worst case scenario with the HDHP/HSA would cost a family $3000.

The other thing my employer did to entice people to sign up for the HDHP was offer a one time deposit into their HSAs. In January they put $1,300 into my HSA ($750 for single) to help fund the account. This was to cover any expenses that might occur before the funds were able to build up. This year they've reduced the amount quite a bit because they figure those of us who've had the account for a few years should (hopefully) have a cushion built up.

These incentives worked, in 2013, 80% of the benefit eligible employees at my company were enrolled in the HDHP/HSA. This is saving the company a lot of money because they no longer have to pay 80% of the premiums for the regular plan (employees paid 20%) and employees are becoming smart shoppers (since they have more skin in the game).

Sorry for the book, I think HDHP w/HSAs are the future and I wish more people knew more about them. I really see more and more companies going with this.

My original transition deal was similar - the company did a first year match into the HSA up to $1200 or something. I switched companies and the deal wasn't as good, and then quit that job and we are on our third HDHP with an HSA.

It is more expensive for people who use more healthcare - people who are healthy do well. But then, if you need more healthcare, maybe you need to pay more - unless we move to a universal health care system where we pay for everyone out of taxes. If this is going to be about the "free market"- I don't want to pay more for my relatively healthy family to subsidize someone's $1500 a month in medications for chronic illness. If its not going to be about the free market - lets get government centered UHC and be done with it. I'll go either way - but I really wasn't happy paying $7000 in premiums, plus the copays, plus whatever my employer stuck into the system, so that I could get a pap smear every other year and the kids could go to the doctor for strep once a year - just in case. I'd rather pay $2000 in premiums and maybe, if something catastrophic happens, I'll have to find $6k.

 

[pryncess527]

One of many reports estimating that obamacare will add 6.2 trillion to the federal deficit:

http://www.nationalreview.com/corne...s-62-trillion-long-term-deficit-andrew-stiles

.

Did you actually read that report by the GAO which is the basis for the article? It said that the ACA could increase OR decrease the deficit over the next 75 years depending on whether or not certain provisions of the bill survive. To get the 6.2 trillion number cited, one has to assume that the worst case scenario occurs and then add up the costs over 75 years to get the number that high. The exact same report paints a number of other scenarios, including one that leads to substantial deficit reduction. I think the truth is probably closer to somewhere in the middle, but to act like either extreme is a factual truth is just disingenuous.

And even in that worst case scenario, 6.2 trillion over 75 years would be a fraction of what we've spent in Afghanistan. I'd rather spend that money on taking care of our population instead of bombing others. Maybe the deficit hawks could work on that one.

 

[SEA333]

Worried about the prospect??!! LOL

I just had my benefits meeting this morning. Our premiums are going up $200/month...or $100/paycheck.

Terrific.

 

[kjetjl]

The company DH works for had negotiated a deal with insurance for a 5 year contract to keep costs down. When Obamacare passed, all deals were off. Last year, our premium INCREASED by $1500/per year. This year premium stayed the same but copay went up, deductible went from $500 per year per family to $2000 per year for family. When deductible is met, we now have to pay 20% rather than 10%.

Insurance has always gone up a bit each year but nothing like the increases we have seen over the last couple years. We have been told by HR that the insurance companies have explained to them it is due to Obamacare.

 

[Jennabeth]

My original transition deal was similar - the company did a first year match into the HSA up to $1200 or something. I switched companies and the deal wasn't as good, and then quit that job and we are on our third HDHP with an HSA.

It is more expensive for people who use more healthcare - people who are healthy do well. But then, if you need more healthcare, maybe you need to pay more - unless we move to a universal health care system where we pay for everyone out of taxes. If this is going to be about the "free market"- I don't want to pay more for my relatively healthy family to subsidize someone's $1500 a month in medications for chronic illness. If its not going to be about the free market - lets get government centered UHC and be done with it. I'll go either way - but I really wasn't happy paying $7000 in premiums, plus the copays, plus whatever my employer stuck into the system, so that I could get a pap smear every other year and the kids could go to the doctor for strep once a year - just in case. I'd rather pay $2000 in premiums and maybe, if something catastrophic happens, I'll have to find $6k.

I know, once I added up the premiums we paid vs the care we actually received, we were paying a lot more in premiums every year. It was frustrating, but I guess that's the nature of insurance (don't get me started on car insurance, LOL).

We were told HDHP plans work best if you are really heathly, or a high utilizer. I know we are very lucky that we haven't had a catastrophic event or illness, but now if we do we should be covered. I really feel like my HSA is like a retirement account. I'm saving now while I can so I can be covered later.

 

[crisi]

The company DH works for had negotiated a deal with insurance for a 5 year contract to keep costs down. When Obamacare passed, all deals were off. Last year, our premium INCREASED by $1500/per year. This year premium stayed the same but copay went up, deductible went from $500 per year per family to $2000 per year for family. When deductible is met, we now have to pay 20% rather than 10%.

Insurance has always gone up a bit each year but nothing like the increases we have seen over the last couple years. We have been told by HR that the insurance companies have explained to them it is due to Obamacare.

Yeah, the insurance companies lie like dogs. ACA does have something to do with it, but insurance premiums have been rising faster than inflation for a lot of years and for a lot of reasons. One is that health care is a victim of something called Baumol's cost disease - this is where certain service heavy industries have costs that increase faster than inflation - because you can't get technological efficiencies from them - they are labor intensive - it always takes one nurse or technician to do a throat swab - you don't get an assembly line throat swabbing robot. Another is that medicine is heavily reliant of expensive R&D costs - and those costs need to be recouped. If you get cancer, you want the best - and that's usually the latest drug, still under patent, with all the R&D costs of it - and all the drugs that weren't successful but we had to try - attached to it. And its heavily reliant on technology - a mammogram machine is a few million dollars - and a newer mammogram machine is going to have a better resolution than one a few years old - which one do you want? Finally, insurance companies are publicly traded firms - they have a responsibility to their shareholders to make as much money as possible. There is a profit motive in insurance. Hospitals used to be primarily charitable or public endeavors - but more of them are private with a profit motive as well. When everyone is taking a profit out of your throat swap - from the doctor (who after all needs a salary) to the nurse (again who needs to get paid) and the lab technician (ditto), to the company that owns the clinic who employs the doctor/nurse/lab technician (and has to pay for the facility, plus the administrative staff who will handle all the billing and order the supplies), and the insurance company also needs to take a profit (and they need to pay for their staff that negotiates payment schedules for the strep throat swab and handles the billing and makes sure you haven't hit your out of pocket maximum before they get a profit) is it any wonder that what takes you ten minutes in a doctors office ends up costing $50?

 

[racefanof88]

I went to healthcare.gov just to see what my insurance costs would be if we went with the plans offered...........this is what I was shown



My premium came out to be $7,410 per year


Out of Pocket Costs

Your out-of-pocket maximum for a Silver plan (not including the premium) can be no more than $12,700. Whether you reach this maximum level will depend on the amount of health care services you use. Currently, about one in four people use no health care services in any given year.

You are guaranteed access to a Silver plan with an actuarial value of 70%. This means that for all enrollees in a typical population, the plan will pay for 70% of expenses in total for covered benefits, with enrollees responsible for the rest. If you choose to enroll in a Bronze plan, the actuarial value will be 60%, meaning your out-of-pocket costs when you use services will likely be higher.Regardless of which level of coverage you choose, deductibles and copayments will vary from plan to plan, and out-of-pocket costs will depend on your health care expenses. Preventive services will be covered with no cost sharing required.


Yeah, this is affordable..............NOT!!!

 

[disney1990]

We have our insurance coverage through my husband's employee -- and pay nothing.

Health insurance coverage through my employer with an HMO is $187 a month (including prescription coverage) for DH & myself. Medical coverage is provided for all part-time employees; I only work 20-25 hours a week.

 

[pryncess527]

I went to healthcare.gov just to see what my insurance costs would be if we went with the plans offered...........this is what I was shown

My premium came out to be $7,410 per year

How did you get to a price? I went to that calculator and answered their questions several different ways, but never got a figure. It just tells me figures will be published Oct 1st

Prices of Marketplace plans have not been set yet. Prices will be available October 1, 2013, when open enrollment starts and you can begin shopping.

 

[disney1990]

How did you get to a price? I went to that calculator and answered their questions several different ways, but never got a figure. It just tells me figures will be published Oct 1st

http://www.washingtonpost.com/wp-srv/special/national/health-care-profiles/calculator/?hpid=z2

Try this link - but is only an estimate of cost.

 

[racefanof88]

...and at least you have a pension...

the thing people are not talking about here is coverage. These exchanges will basically, if I'm understanding it at all, be kind of like Medicaid, where doctors will get super low pay for their services. Many do not want and cannot afford to have many patients that pay so low..if these exchanges bump millions into the low payout camp then millions may not be able to find providers to have health care. That's where this will all crumble. The mess my DH went through before he could start treatment was a nightmare before Obamacare was fully implemented was amazing, I can't imagine how much of a mess it will be come January and future years. Not to mention the costs to the goverment are absolutely staggering..and there is no where for that money to come from. Deck of cards..

You are SOOOOO right!!! As a nurse I listen to the doctors talking about the changes they are making in their practices. There are some who have outright retired because they did not want to deal with the headaches. There are doctors who have said they are going, and some have gone, to a cash only practice, so insurance will be worthless for an office visit. They are having the patient pay up front then giving them the information to file with their own insurance. This will eliminate the need for an insurance clerk in the practice.

All the doctors, and healthcare facilities, in my area have started making the patients pay their deductible, co-pay and co-insurance up front before they ever see a doctor, so don't get the flu if you haven't met your $1000 deductible.

To help with the expected influx of patients several practices are adding concierge care services. This will really separate the upper income from the middle and lower income. For those who are unfamiliar with concierge care it works like a gym membership. To become a concierge patient you would pay your doctor a 'membership' fee monthly, or yearly, depending on what the practice implements. This fee does not go to pay for any medical treatment at all, but it gets you "front of the line" access to your doctor. If he has 30 people in his waiting room and a concierge patient calls in, those 30 in the waiting room keep right on waiting while the concierge patient walks right in. The doctors are giving out their home phone numbers, cell numbers, private office numbers; you have full access to your doctor.

There are also doctors who are limiting the number of patients they admit to their practice. We run into it all the time with the pediatricians not accepting any new patients to their practice. We also are seeing doctors who are no longer admitting patients to the hospital so the patients are having to see the hospitialist (who are usually doctors who have been either kicked out of a practice or were not hired by a practice). The hospitalist will not follow up with you after you discharge because they don't have an office to do so.

Then you have the doctors who limit the number of patients by insurance. They only take on so many Medicare/Medicaid/BCBS/Tricare...etc patients per practice.

Someone made a comment about the coding issues........OMG........ The current ICD-9 codes are going away to be replaced by the ICD-10 codes and you would be shocked at how easy it is to mess up a code!!!! If the code is supposed to be for an ear infection, and the doctor puts in even one character wrong(very easy to do)..........THE WHOLE VISIT IS DISALLOWED, even if the patient had and ear infection, sinus infection, fever, blood work etc.etc. Hospitals are having whole stays disallowed and any monies paid taken back. Guess who gets the bill then...........THE PATIENT.

 

[dansamy]

And guess who eats that bill when it's written off as bad debt because the patient can't afford it? That's right. The doctor, hospital, et al.

A ROUTINE ******l delivery, with no anesthesia and no complications costs, not any profit margin but the actual expense of the service is $X. Medicaid pays our hospital less than half of that. We lose money on EVERY Medicaid birth. Then, if you add in any additional services such as a vacuum, forceps, cesarean, etc, those are all unreimbursed. A special care nursery stay, costing thousands, fuhgeddaboutit.

 

[racefanof88]

How did you get to a price? I went to that calculator and answered their questions several different ways, but never got a figure. It just tells me figures will be published Oct 1st

healthcare.gov took me to this site. >>>>http://kff.org/interactive/subsidy-calculator/

And I answered the questions. Maybe your state isn't showing the info yet!

 

[racefanof88]

And guess who eats that bill when it's written off as bad debt because the patient can't afford it? That's right. The doctor, hospital, et al.

Yep!! That is why a Tylenol is $10. Those who are paying their bill are already paying for those that don't, now we will just have to do it twice.

 

[pryncess527]

healthcare.gov took me to this site. >>>>http://kff.org/interactive/subsidy-calculator/

And I answered the questions. Maybe your state isn't showing the info yet!

Okay, that's what I figured. Those are only estimates. Prices will be available October 1st.

 

[Colleen27]

Yep!! That is why a Tylenol is $10. Those who are paying their bill are already paying for those that don't, now we will just have to do it twice.

You don't think that with fewer unpaid bills the costs of services will come more in line with the actual cost of providing them? You expect that the prices will remain at the current high levels, which are set to compensate for non-payment, even when the numbers of non-paying patients fall?

 

[leahjade]

on the news today

Consumers may have to dig a little deeper into their wallets to pay for health care in the Obamacare insurance exchanges, according to a new analysis by Avalere Health.

The study of six states suggests that consumers could face steep cost-sharing requirements — like co-payments, co-insurance and deductibles — layered on top of their monthly premiums.


The health law sets exchange enrollees’ maximum annual out-of-pocket costs at $6,350. But many people won’t get near that limit, and deductibles for typical exchange plans can run twice as high as the average employer-sponsored plan.

 

[racefanof88]

And guess who eats that bill when it's written off as bad debt because the patient can't afford it? That's right. The doctor, hospital, et al.

A ROUTINE ******l delivery, with no anesthesia and no complications costs, not any profit margin but the actual expense of the service is $X. Medicaid pays our hospital less than half of that. We lose money on EVERY Medicaid birth. Then, if you add in any additional services such as a vacuum, forceps, cesarean, etc, those are all unreimbursed. A special care nursery stay, costing thousands, fuhgeddaboutit.

Looks like we work in the same specialty. The new thing with all the insurance companies is that as soon as the newborn is anything but "normal"...i.e. jaundiced, low blood sugars, heart murmur, preterm.....ANY thing but the perfect Gerber baby, that baby is now an individual patient and is subject to all co-pays, co-insurance and deductibles. At one time the minor issues did not create the separation of mom and baby as individual patients.

We are seeing more and more 25 year olds coming in to deliver, still on their parent's insurance, and finding out that the baby is NOT covered under their parent's plan!! There have been some who have signed guardianship of the infant over to the parent to keep from having to pay the hospital bill for the baby. I guess Obamacare forgot to include grandchildren as a dependent.

 

[racefanof88]

You don't think that with fewer unpaid bills the costs of services will come more in line with the actual cost of providing them? You expect that the prices will remain at the current high levels, which are set to compensate for non-payment, even when the numbers of non-paying patients fall?

NO, I don't see it coming down at all. If you look at the deductibles these so called insurances will have, you will still have people defaulting on hospital bills. People will be using the ER as a clinic and when they have a $6000 deductible, they will not have the money to pay their bill.

These plans are going to be more along the lines of major medical benefits, NOT the type of insurances that most people are thinking. If you have an out of pocket expenditure of $12,700 then you really don't have insurance at all unless, God forbid, you have some catastrophic event.