Anyone Else Worried About Health Premiums Going UP?

[TwoAtDisney]

Jennebeth & Crisi, thanks for so much info. I don't think my DS would be a candidate for it - he would spend the HSA money for non-health care!

RaceFanof88 -
1. My premium came out to be $7,410 per year - That sounds like the pre-credit price??? Unless you have higher than average income.

2. As a nurse I listen to the doctors talking about the changes they are making in their practices. - This is no different that when Medicare/Medicaid started. Decades ago, I worked in the health care industry & heard the same remarks. But I don't understand it as it relates to ObamaCare - the employer policies are staying the same as far as paying the dr, just costing the employees more. The insurance companies on the exchanges are charging big bucks to the consumer, which is lower by the a tax credit, not lower payments to the drs/hosps. So except for new Medicaid patients, how does ObamaCare change payments to drs/hosps?

3. 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 - ALL???? I don't think so. Those who do will lose a lot of patients, so unless they retire or get new jobs, they'll change that rule!

4. Concierge practices are not new; decades old.

5. Not accepting new patients is nothing new. That was happening decades ago. A physician builds his/her practice & cuts off new patients because he/she can only handle so many. Twenty years ago I got into my Mom's dr. only because I was her daughter - he was not accepting new patients.

6. There are some doctors who do NOT accept Medicare/caid/tricare, etc. That also is not new. Last year, I went to a specialist who only had one day a month when he would see Medicare patients. That's their choice, but nothing new with ObamaCare.

None of the above is a "new thing" due to ObamaCare. I'm sure there are still colleges full of medical school students - it's still a great job compared to most of us!

Dansamy - 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.
1. The hospitals make this up by charging big bucks to the full paying insurance covered patients.
2. Half of a bill is better than zero - no Medicaid - arrives in emergency room, treated without Medicaid!
3. Hopefully you are not saying that in America, the low income should birth their babies on the sidewalk? Have you ever been to India? Do you really want that in America? Would that improve your lifestyle? Would that make you feel better about paying lower health insurance premiums?

Come on. Let's get real. Obamacare is new. No one knows the results a year, 2 years, or so from now. The insurance companies MUST pay 80% of their premiums in health care costs. After a year, maybe it will all fall out & those premiums/copays/etc will have to come down. I don't know, but neither does anyone else.

I sympathize with those whose costs are going up drastically. IMO, each of you have valid reasons for complaining, worrying, etc. As for the rest of non-factual, generalizing info, IMO, as McCain said yesterday, it's the law of the land, work with it & wait & see how it all works.

 

[dansamy]

I work peds, but I'm cross trained to post-partum & well-baby. Most of my OT is worked there.

TwoAtDisney - no. I don't think the poor should birth their children on the sidewalk. That's ridiculous to insinuate that. I DO think that the hospitals & doctors should be reimbursed for the EXPENSE of a delivery. We're not talking about profit. We're talking about the wholesale COST to the hospital and physician for providing services for a ROUTINE, uncomplicated delivery. They pay less than half of our actual expense. That's a losing proposition. There are some rural hospitals who do not offer ob services because of the increased unreimbursed EXPENSE. Again, we're not talking about profit. We're talking about the bare minimum wholesale cost of that service. There are women in rural counties who must drive over two hours to get to a birthing facility.

 

[racefanof88]

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

If you have employer sponsored insurance you don't qualify. You can't get insurance through the exchange.

You do realize that by estimate it can also be higher?

 

[Colleen27]

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.

That's a max OOP, not a deductible. The specifics of each plan regarding deductibles and copays will vary from company to company. The exchange is a marketplace, not a product. And all of the plans will operate within the new rules about preventative care coverage.

 

[pryncess527]

If you have employer sponsored insurance you don't qualify. You can't get insurance through the exchange. You do realize that by estimate it can also be higher?

of Course. It's an estimate. I was just trying to differentiate between what was published fact and what was hypothesis. I think Kaiser has made many errors in their other estimates related to Obamacare so I have some reason to believe that it may end up being lower but we will find out on Tuesday. I'm also wondering if you included the subsidy for the plan, since it seems you did not cut-and-paste that part of the page. Perhaps you were not eligible for a subsidy, though many or not but most people are. And I do not think it is straight across-the-board that people who are eligible for employer paid health insurance cannot purchase from the exchange. The healthcare.gov site seems to indicate otherwise. So much of the hysteria about Obamacare strikes me as similar to the hysteria about the guest access cards at Disney. Lots of people freaking out about rumors and not basing their fears on valid information. I'm not saying no one has anything to be worried about, but it seems like a lot of the concerns may be exaggerated

 

[racefanof88]

Jennebeth & Crisi, thanks for so much info. I don't think my DS would be a candidate for it - he would spend the HSA money for non-health care!

RaceFanof88 -
1. My premium came out to be $7,410 per year - That sounds like the pre-credit price??? Unless you have higher than average income.

NO that is the POST credit price!! Unsubsidized annual health insurance premium in 2014 $13,021. And as I nurse I can assure you I don't have a higher than average income........ROFLMAO

2. As a nurse I listen to the doctors talking about the changes they are making in their practices. - This is no different that when Medicare/Medicaid started. Decades ago, I worked in the health care industry & heard the same remarks. But I don't understand it as it relates to ObamaCare - the employer policies are staying the same as far as paying the dr, just costing the employees more. The insurance companies on the exchanges are charging big bucks to the consumer, which is lower by the a tax credit, not lower payments to the drs/hosps. So except for new Medicaid patients, how does ObamaCare change payments to drs/hosps?

It is directly related to Obamacare!! The employer policies ARE NOT staying the same, our insurance has changed DRASTICALLY and yes it is costing ME the employee more(that is a change if you ask me, NOT affordable at all). The payments to the doctors and hospitals is being lowered by the fact that if you develop a secondary condition while in the hospital...... IT IS NOT PAID....only your original diagnosis. Private insurance companies are now paying at the same rate Medicare/Medicaid is paying which is well below what private insurance once paid.

3. 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 - ALL???? I don't think so. Those who do will lose a lot of patients, so unless they retire or get new jobs, they'll change that rule!

Yes ALL private doctors, and even the stand alone Doc's in a box. Why would they lose patients? All the newly insured will have to see somebody, right? Pay up front and then you fight with your insurance carrier!!

4. Concierge practices are not new; decades old.

But very, VERY rare in my area!! This practice again costs patients more, again NOT AFFORDABLE.

5. Not accepting new patients is nothing new. That was happening decades ago. A physician builds his/her practice & cuts off new patients because he/she can only handle so many. Twenty years ago I got into my Mom's dr. only because I was her daughter - he was not accepting new patients.

So who do you think is going to see all these new patients? Likely a doctor I wouldn't even take my furry baby to see.

6. There are some doctors who do NOT accept Medicare/caid/tricare, etc. That also is not new. Last year, I went to a specialist who only had one day a month when he would see Medicare patients. That's their choice, but nothing new with ObamaCare.

Once a month huh? That is comforting. Again I ask; who will these newly insured patients see? Everyone will have insurance, but it will be a useless piece of paper!!

I sympathize with those whose costs are going up drastically. IMO, each of you have valid reasons for complaining, worrying, etc. As for the rest of non-factual, generalizing info, IMO, as McCain said yesterday, it's the law of the land, work with it & wait & see how it all ends.

Or see how it all collapses in around us !!!!

 

[TwoAtDisney]

I work peds, but I'm cross trained to post-partum & well-baby. Most of my OT is worked there.

TwoAtDisney - no. I don't think the poor should birth their children on the sidewalk. That's ridiculous to insinuate that. I DO think that the hospitals & doctors should be reimbursed for the EXPENSE of a delivery. We're not talking about profit. We're talking about the wholesale COST to the hospital and physician for providing services for a ROUTINE, uncomplicated delivery. They pay less than half of our actual expense. That's a losing proposition. There are some rural hospitals who do not offer ob services because of the increased unreimbursed EXPENSE. Again, we're not talking about profit. We're talking about the bare minimum wholesale cost of that service. There are women in rural counties who must drive over two hours to get to a birthing facility.

OK; I'm curious.

You don't think the poor should birth on the sidewalks, but you don't think they should be able to receive only half paid services????

I DO think that the hospitals & doctors should be reimbursed for the EXPENSE of a delivery - They are! They are fully reimbursed by charging higher prices to insured patients - this is a major complaint by many Americans about health care! It happened in the past, it happens now, & it will happen in the future. It's standard operating procedure.

So, I'm confused ......You are not complaining about poor people receiving health care. Are you saying the government (we, the tax payers) should reimburse the hosps/drs for the full costs, not just 1/2 the costs like we do now? I'm not knocking that, it justs seems 6 of one & half dozen of the other to me. If this would happen, then rather than insurance patients paying the extra costs, taxpayers would pay it via taxes - which most of them are probably the same people.

Or, is there a 3rd option that I have missed? Sometimes I can be dense!

 

[racefanof88]

That's a max OOP, not a deductible. The specifics of each plan regarding deductibles and copays will vary from company to company. The exchange is a marketplace, not a product. And all of the plans will operate within the new rules about preventative care coverage.

I hate to argue, but a deductible is NOT a max out of pocket, it is just want it says a deductible. The max out of pocket for the plan I was quoted was $12,700, so that would mean AFTER I met my $6000 deductible the most I would be out of pocket would be an additional $6700. That $6000 would have to be paid before the insurance paid the first dime!!

My husband works for a small company, about 25 employees, the insurance offered by his employer is as follows .

(1) The price is $175 a WEEK, yes I said a week, for a family of 3+.
(2) The deductible is $1500 per person up to 4 people
(3) NO Rx coverage.
(4) NO dental coverage
(5) NO vision coverage
(6) NO mental health coverage
(7) $150 a day co-pay per hospital stay(does NOT go toward deductible)
(8) 70/30 coverage
(9) $35 co-pay per doctor visit(does NOT go toward deductible).

A couple of the workers are single moms who CANNOT afford those prices and since their employer is offering insurance, they can't go into the exchange.

 

[pryncess527]

A couple of the workers are single moms who CANNOT afford those prices and since their employer is offering insurance, they can't go into the exchange.

That is NOT true. They may not be eligible for a subsidy depending on the plan their employer offers, although if it is as horrible as you described that implies that they would be eligible for the subsidy. But even people who are not eligible for a subsidy can buy health insurance from the exchange.

 

[racefanof88]

OK; I'm curious.

You don't think the poor should birth on the sidewalks, but you don't think they should be able to receive only half paid services????

I DO think that the hospitals & doctors should be reimbursed for the EXPENSE of a delivery - They are! They are fully reimbursed by charging higher prices to insured patients - this is a major complaint by many Americans about health care! It happened in the past, it happens now, & it will happen in the future. It's standard operating procedure.

So, I'm confused ......You are not complaining about poor people receiving health care. Are you saying the government (we, the tax payers) should reimburse the hosps/drs for the full costs, not just 1/2 the costs like we do now? I'm not knocking that, it justs seems 6 of one & half dozen of the other to me. If this would happen, then rather than insurance patients paying the extra costs, taxpayers would pay it via taxes - which most of them are probably the same people.

Or, is there a 3rd option that I have missed? Sometimes I can be dense!

You are not seeing the whole picture, only half!! Private insurance companies are now reimbursing at the same rate as Medicare/Medicaid, so it doesn't matter what the charges may be. When a contract with an insurance company is negotiated there are set prices for a set procedure, PERIOD. IF anything, and I mean ANYTHING, goes wrong........mom gets an Ileus after a C-Section because she didn't listen to the doctor about ingesting only clear liquids post-op day one. Guess what? The doctor NOR the hospital gets insurance reimbursement for the care mom receives related to the Ileus!!

You seem to forget too the UNREASONABLLY high cost of malpractice insurance the doctors, and hospital, have to carry because people want to sue if they fart wrong. And as OP said, there are doctors, and hospitals, getting out of the baby business in droves!! If the 12 hospitals within a 100 mile radius of where I live, 6 have stopped delivering babies all together.

 

[lauradis]

That is NOT true. They may not be eligible for a subsidy depending on the plan their employer offers, although if it is as horrible as you described that implies that they would be eligible for the subsidy. But even people who are not eligible for a subsidy can buy health insurance from the exchange.

What previous poster is getting at is Health insurance isn't affordable for lots of people that are barely making it paycheck to paycheck.

 

[pryncess527]

What previous poster is getting at is Health insurance isn't affordable for lots of people that are barely making it paycheck to paycheck.

That is not what she said. She perpetuated a common misconception that if your employer provides coverage you can not shop the exchange. That is not true and needed to be corrected. And I get it. Even subsidized government health insurance for a poorly paid single mother of two may not be affordable (Though frankly the figures I have seen make that pretty unlikely I am amazed at how low the rates have gotten in most states.) . That person wouldn't pay a fine if they didn't carry health insurance, but to be quite honest even that government subsidized health insurance is a hell of a lot cheaper than getting sick without it. And there are many people in that situation were going to be getting health insurance practically for free, they are really going to benefit.

 

[crisi]

I hate to argue, but a deductible is NOT a max out of pocket, it is just want it says a deductible. The max out of pocket for the plan I was quoted was $12,700, so that would mean AFTER I met my $6000 deductible the most I would be out of pocket would be an additional $6700. That $6000 would have to be paid before the insurance paid the first dime!!

My husband works for a small company, about 25 employees, the insurance offered by his employer is as follows .

(1) The price is $175 a WEEK, yes I said a week, for a family of 3+.
(2) The deductible is $1500 per person up to 4 people
(3) NO Rx coverage.
(4) NO dental coverage
(5) NO vision coverage
(6) NO mental health coverage
(7) $150 a day co-pay per hospital stay(does NOT go toward deductible)
(8) 70/30 coverage
(9) $35 co-pay per doctor visit(does NOT go toward deductible).

A couple of the workers are single moms who CANNOT afford those prices and since their employer is offering insurance, they can't go into the exchange.

Actually, a lot of dimes would be paid - preventative care, vaccinations, mammograms - all that sort of healthy care will be paid for by the insurance company and not count against your deductible.

If you aren't healthy and need to go to the doctor for a chronic condition, or you get ill or injured, that is really when the costs kick in. The year we crack my husband's spine open so he isn't paralyzed, we will finish out our deductible and hit out of pocket maximums.

Much of this is in reaction to an American public who doesn't take care of themselves and wants someone else to pay the health care costs. We bring on a lot of our chronic conditions onto ourselves - smoking, eating crap, not exercising, weighing more than we should, engaging in dangerous behavior. Now, many health concerns we don't bring on ourselves (my husband's spine is genetic - nothing he can do or stop doing to prevent the calcification), but a lot of our health care costs are our own darn fault - including my husband's sleep apnea (he's overweight), my depression (I let myself get overstressed), my father's diabetes (when type II diabetes happens on BOTH sides of your family, cut out sugared soda and empty carbs and start getting exercise before you are 60 and get your diagnosis).

 

[racefanof88]

That is NOT true. They may not be eligible for a subsidy depending on the plan their employer offers, although if it is as horrible as you described that implies that they would be eligible for the subsidy. But even people who are not eligible for a subsidy can buy health insurance from the exchange.

You are right in that they may fall below the "federal poverty" level for their family size, they will still have to pay for the insurance in the exchange. One of the girls(a friend of mine) would still have to pay out $167.41 a month for coverage in the exchange. Money she does not have!! She has two children she is raising alone on a PRE TAX income of ~$36,000 a year. That $167 is what she has to buy groceries with!!

 

[racefanof88]

What previous poster is getting at is Health insurance isn't affordable for lots of people that are barely making it paycheck to paycheck.

Thank you, someone finally gets it!!!

 

[pryncess527]

You are right in that they may fall below the "federal poverty" level for their family size, they will still have to pay for the insurance in the exchange. One of the girls(a friend of mine) would still have to pay out $167.41 a month for coverage in the exchange. Money she does not have!! She has two children she is raising alone on a PRE TAX income of ~$36,000 a year. That $167 is what she has to buy groceries with!!

That's a fourth of the price you said her employer was trying to charge, so sounds like a pretty good deal to me. Again I get that is expensive but it's cheaper than getting sick. And she doesn't have to buy anything, she's low enough income that no one's gonna charge for a penalty for not having insurance. So how is she worse off ?

 

[dansamy]

ACA is creating a whole new set of problems while doing precious little in the way of solving very many of the old problems. Of course, time will tell all. We'll see what happens as it happens, but my early opinion is that it's not going to be all that great in the long run.

 

[averysmom]

I work peds, but I'm cross trained to post-partum & well-baby. Most of my OT is worked there.

TwoAtDisney - no. I don't think the poor should birth their children on the sidewalk. That's ridiculous to insinuate that. I DO think that the hospitals & doctors should be reimbursed for the EXPENSE of a delivery. We're not talking about profit. We're talking about the wholesale COST to the hospital and physician for providing services for a ROUTINE, uncomplicated delivery. They pay less than half of our actual expense. That's a losing proposition. There are some rural hospitals who do not offer ob services because of the increased unreimbursed EXPENSE. Again, we're not talking about profit. We're talking about the bare minimum wholesale cost of that service. There are women in rural counties who must drive over two hours to get to a birthing facility.

What are these costs? These wholesale costs? I am Canadian, and my dd fell and hit her head in Disney 5 years ago, and our emergency room visit for 3 staples was $1700.00. This was for the hospital and the doctor. I just about fell off my chair! Thank goodness I had travel insurance. To compare, an ER visit here, with a similar injury would have cost a non-citizen around $400.00. How can health care be that more money in the US? I looked for figures on delivery, but the most recent I could find was from 2002-03. A non-complicated ******l birth could cost a non-citizen ( no free health care) $2700.00. Doctor and hospital. Even assuming that the price has gone up by 50% in 10 years, it would still only be $4000.00. How much would that birth cost me in the us? I bet more than that, even at "wholesale" costs. Why? Why is it so expensive?

 

[lauradis]

But when is enough enough. Dh and me are well over the 400% mark. In fairly good health, paid less then total of 3k for all medical expenses in 2012. (minus over the counter stuff) Our employer based plan is "Cadillac" cost in 2012 with dental and vision riders was over 24k for family of 4. We can kiss that good bye in next couple of years.

If I haven't mis read the obamacare government website

Tax benefits for all health saving plans are going away

 

[racefanof88]

That is not what she said. She perpetuated a common misconception that if your employer provides coverage you can not shop the exchange. That is not true and needed to be corrected. And I get it. Even subsidized government health insurance for a poorly paid single mother of two may not be affordable (Though frankly the figures I have seen make that pretty unlikely I am amazed at how low the rates have gotten in most states.) . That person wouldn't pay a fine if they didn't carry health insurance, but to be quite honest even that government subsidized health insurance is a hell of a lot cheaper than getting sick without it. And there are many people in that situation were going to be getting health insurance practically for free, they are really going to benefit.

It is not free no matter how you look at it, tax dollars will pay for it. Also, If they qualify for free healthcare under ACA then they likely qualified for it BEFORE the ACA. When you have a single mother struggling to put food on the table, pay her bills, and keep a roof over her kids head, then even $25 a week hurts. If the numbers on the calculator are correct she will have to pay $38.63 a week. My friend goes to Goodwill to buy their clothes, she buys marked down meats, goes to the bread store to buy day old bread, she drives a 1998 Buick with tires so thin you can see the air in them. She clips coupons, NEVER eats out, won't even let her kids have a dog because she can't afford to feed it. So she is going to benefit how? I guess she will fit the government's plan of how skinny everyone should be because she won't have the money to buy food.